中国循证医学杂志

中国循证医学杂志

针灸治疗多囊卵巢综合征的系统评价再评价

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目的 评价针灸治疗多囊卵巢综合征(PCOS)系统评价的方法学质量和证据质量分级。 方法 计算机检索 PubMed、EMbase、The Cochrane Library、CBM、CNKI 和 WanFang Data 数据库,搜集针灸治疗 PCOS 的系统评价,检索时限均从建库至 2018 年 1 月 5 日,采用 AMSTAR 工具评价纳入系统评价的方法学质量,使用 GRADE 系统对纳入系统评价的结局指标进行证据质量分级。 结果 共纳入 11 个系统评价。AMSTAR 工具评价结果显示,11 个条目中,条目 5“是否提供了纳入和排除的研究文献清单”风险最高,其次是条目 1“是否提供了前期设计方案”和条目 11“是否说明相关利益冲突”。GRADE 分级结果显示,所有结局指标的证据质量均为低或极低。 结论 当前针灸治疗多囊卵巢综合征患者的系统评价方法学质量不高,所有结局指标的 GRADE 证据质量级别较低。因此,今后在设计临床试验时应严格规范试验设计,做更多高质量、大样本的随机对照试验来评估针灸治疗 PCOS 的疗效及安全性,并应规范针灸临床研究的方法学质量和报告质量,以期提高临床证据的证据质量和推荐意见强度。

Objective To evaluate the methodological bias and the reliability of the conclusions of systematic reviews about acupuncture for polycystic ovary syndrome. Methods We comprehensively searched PubMed, EMbase, The Cochrane Library, CBM, CNKI and WanFang Data to collect systematic reviews of acupuncture for polycystic ovary syndrome from the establishment time of databases to January 5th, 2018. The AMSTAR tool was applied for methodological quality assessment of included studies and the GRADE system was applied for evidence quality assessment of included outcomes of systematic reviews. Results A total of 11 systematic reviews were included. The results of assessment using AMSTAR showed that, among 11 items, there were the most problems concerning Item 5" Were there any lists of research articles included and excluded”, followed by Item 1" Was an‘a prior’design provided?”and Item 11" Were potential conflict of interest included?”. GRADE grading results showed that quality of evidence for the outcome measure were" low”or" very low”. Conclusion Current acupuncture treatment of polycystic ovary syndrome has a certain effect, but the quality of evidence is low. Thus, physicians should apply the evidence to make decision about acupuncture for polycystic ovary syndrome with cautious in clinical practice and consider the actual situation, combined with the patient’s value preferences and economic factors.

关键词: 针灸; 多囊卵巢综合征; 系统评价再评价; AMSTAR; GRADE 分级

Key words: Acupuncture; Polycystic ovary syndrome; Overview of systematic review; AMSTAR; GRADE system

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