原发性醛固酮增多症诊断指引的评价-2019年文档

1、原发性醛固酮增多症诊断指南的评价Purpose: There has been a rapid expansion in the number of clinical practice guidelines for primary aldosteronism (PA) over the past decade, but little is known about which guidelines(GLs) to follow. Therefore, this study is done to assess the quality of the GLs, and to give advice o

2、n the recommendation on diagnosis of PA for future. Methods: After systematic searches of pubmed and electronic guideline databases between 1999 and 2008, 9 PA GLs were selected and scored for methodological quality using the AGREE Instrument. Then we extracted and compared recommendations amonga ra

3、nge of guideline and analyzed to what extent the variation or concordance among recommendations was explained by the evidence cited in the guideline.Results: Of the 3192 referrences, 9 GLs were evaluated by the AGREE instrument. 2 GLs, were strongly recommended, and 2 GLs ,recommended with alteratio

4、n, but 5 GLs would not be recommend. The recommendations made in the guidelines were in agreement about general diagnosis of PA, with some important differences in details. There was little overlap in evidence cited by the guidelines.Conclusions: It is evident that there are disparities in diagnosti

5、c recommendation in guidelines for PA, reflecting unsystematic guideline development, insufficient evidence, differing interpretation of evidence, the influence of professional bodies. Therefore, efforts will be further needed to close the evidence gaps in the field of the diagnosis of PA and to cre

6、ate a joint task force to reach a common document by using the AGREE criteria.KeywordsAGREE;primary aldosteronism;diagnose;guideline;evidence-based medicine引言 原发性醛固酮增多症是由醛固酮分泌过多所致的一种常见 的内分泌性高血压。原发性醛固酮增多症在普通的高血压中占 6.1%1, 在顽固性高血压中占 17%2 或 20%3, 在肾上腺意外 瘤中占 1.6%4 。另外 , 越来越多地研究显示原发性醛固酮增多 症病人心血管事件的患病率和病死率

7、比同年龄 , 同性别的高血压 病人更高 5 。而原发性醛固酮增多症是需要根据不同的病因进 行治疗的 , 如醛固酮瘤需行单侧肾上腺切除术 , 而双侧肾上腺增 生需醛固酮受体拮抗剂的治疗。 因此原发性醛固酮增多症是一种 常见的可识别的 , 可治疗的 , 预后较好的高血压 , 同时也需要临床 医师的及时诊断与鉴别。但是原发性醛固酮增多症的最佳诊断方法现仍有争议 6, 而专家们试图通过临床实践指南来解决这个问题。近 10 年来关 于原发性醛固酮增多症的诊断指南层出不穷 , 却没有关注这些指 南质量的好坏。 McAlister 等人发现 , 不同的指南针对同种疾病 状态建议不同 , 甚至所引用的证据也不

8、同 7 。因此在本研究中 , 我们运用世界公认的AGREE（8工具来对各个原发性醛固酮增多 症诊断指南进行评价 , 其目的是 : 评价原发性醛固酮增多症的 诊断指南质量 ; 指南所提供的建议是否符合指南发展过程中的 循证医学的要求 ; 比较不同指南之间证据和建议的一致性 ; 对原发性醛固酮增多症的筛查和确诊实验提出一些建设性的建 议。1 材料和方法1.1 检索的步骤系统性的检索了有关原发性醛固酮增多症 , 高血压 , 顽固性 高血压和肾上腺意外瘤的指南的文献。目的是获得易检索的, 能在多个国家使用的 , 具有代表性的原发性醛固酮增多症诊断指南 的样本。检索主题词为高血压 /诊断/ 指南或肾上腺意外瘤等 （ 见 表1）。分别由两个评价者独立地在 PubMed,NGC美国国内指南数 据库）,GIN（国际指南网）和NICE（英国国内健康与临床研究所）中 进行查找。1.2 检索条件1.3 数据提取和指南方法学质量的评估两个评估者独立地审阅了相关的指南 , 提取了原发性醛固酮 增多