全球现有儿童特发性血小板减少性紫癜指南的循证评价

中圖分类号 R967；R554+.6 文献标志码 A 文章编号 1001-0408（2018）04-0541-06

DOI 10.6039/j.issn.1001-0408.2018.04.27

摘 要 目的：系统评价全球现有儿童特发性血小板减少性紫癜（ITP）药物治疗的循证指南，为我国儿童ITP临床诊治及指南制定提供循证证据。方法：计算机检索PubMed、Embase、National Guideline Clearinghouse、Guidelines International Network、TRIP指南数据库、中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊数据库、万方数据库等，纳入含有儿童ITP的循证治疗指南，采用指南研究与评价工具（第2版）（AGREEⅡ）工具评价指南的质量，分析并比较各指南推荐的异同。结果：共纳入儿童ITP循证指南7篇，其中美国2篇、意大利2篇、英国2篇、马来西亚1篇。7篇指南总体质量不高，6篇为B级推荐，1篇为C级推荐，且仅1篇为GRADE循证指南。纳入指南在AGREEⅡ各领域得分高低依次为：范围和目的、清晰性、制定的严谨性、参与人员、应用性、编辑的独立性。7篇指南主要推荐用药为：糖皮质激素、静脉注射免疫球蛋白、抗 D-免疫球蛋白，部分指南推荐血小板、利妥昔单抗及联合用药方案。结论：纳入的儿童ITP循证指南用药证据质量低，整体质量有待提高；我国尚无儿童ITP循证指南，建议以AGREEⅡ条目为参考标准，制定适应我国ITP患儿的高质量循证指南。

关键词 儿童特发性血小板减少性紫癜；儿童；指南；循证评价；指南研究与评价工具（第2版）

ABSTRACT OBJECTIVE： To evaluate evidence-based guidelines of current global pediatric idiopathic thrombocytopenic purpura （ITP） drug therapy， and to provide evidence-based reference for pediatric ITP diagnosis and treatment， the formulation of guideline in China. METHODS： Retrieved from PubMed， Embase， National Guideline Clearinghouse， Guidelines International Network， TRIP medical database， CBM， CJFD， VIP and WANFANG DATA， etc.， the evidence-based treatment guideline involving pediatric ITP were included， and methodological quality of the guideline was evaluated by using AGREEⅡtool. The similarities and differences of the guidelines were analyzed and compared. RESULTS： A total of 7 pediatric ITP evidence-based guidelines were included， among which 2 came from US， 2 came from Italy， 2 came from British and another one came from Malaysia. The quality of 7 guidelines were not good， among which 6 guidelines were recommended as grade B and 1 guideline was recommended as grade C； only one GRADE evidence-based guideline was found. The score of included guideline in the field of AGREEⅡwas in descending order as scope and purpose， clarity， rigor of development， stakeholder involvement， applicability， editorial independence. The main recommended drugs of these guidelines were： glucocorticoids， intravenous immunoglobulin， anti-D-immunoglobulin， while some guidelines recommend platelet， rituximab and combined medication. CONCLUSIONS： The quality of evidence-based guidelines of ITP for children is in low level and should be improved. There is no evidence-based guideline of ITP for children in China. It is suggested to develop high quality evidence-based guideline for ITP children in China based on AGREEⅡ items.

KEYWORDS Pediatric idiopathic thrombocytopenic purpura； Children； Guideline； Evidence-based evaluation； AGREEⅡ

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