中国循证医学杂志

中国循证医学杂志

痛风慢性期降尿酸治疗的系统评价再评价

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目的 评价痛风慢性期降尿酸治疗系统评价的方法学偏倚及结论可靠程度。 方法 计算机检索 PubMed、EMbase、The Cochrane Library、Epistemonikos、CBM、WangFang Data 和 CNKI 数据库,搜集公开发表的痛风慢性期降尿酸治疗的系统评价/Meta 分析,检索时限均为建库至 2017 年 4 月 8 日。由 2 名研究者独立筛选文献并提取资料,采用 AMSTAR 工具评价纳入研究的方法学质量,并运用 GRADE 方法对系统评价的结局指标进行证据质量分级。 结果 最终纳入 11 篇系统评价/Meta 分析,所有系统评价均涉及别嘌醇,10 篇涉及非布司他,3 篇涉及苯溴马隆,1 篇涉及丙磺舒。纳入系统评价包含 3 个主要结局指标。10 篇系统评价对纳入原始研究进行了方法学质量评价,其中 8 篇使用 Cochrane risk of bias 偏倚评估工具,2 篇使用其他评价工具。AMSTAR 评价结果显示:4 个系统评价评分≥9 分,其余系统评价评分均≤8 分。GRADE 分级结果显示:20 个结局指标的证据质量为低或极低,10 个结局指标的证据质量为中,2 个结局指标的证据质量为高。 结论 中等质量证据显示非布司他在血尿酸达标方面优于别嘌醇,高质量证据显示两者在急性痛风发生率方面无明显差异,高质量证据显示非布司他安全性优于别嘌醇。其他降尿酸干预尚缺乏来源于系统评价的高质量证据支持。期待未来开展更多科学而严谨的研究,生产更多高质量证据,填补相应空白。

Objective To evaluate the methodological bias and the reliability of the conclusions of systematic reviews (SRs) about urate-lowering therapy (ULT) for chronic gout. Methods PubMed, EMbase, The Cochrane Library, Epistemonikos, CBM, WanFang Data and CNKI databases were electronically searched to collect published systematic reviews and meta-analyses evaluating urate-lowering drugs in chronic gout from inception to April 8th 2017. Two reviewers independently screened literature, extracted data, assessed the methodological quality of included SRs using the AMSTAR tool, and assessed the quality of the body of evidence for each outcome using the GRADE approach. Results A total of 11 relevant SRs were included, containing 3 main outcome measures. All of these SRs contained allopurinol, 10 SRs contained febuxostat, 3 SRs contained benzbromarone and 1 SR contained probenecid. Ten SRs assessed the risk of bias of included original studies. Eight SRs used the" assessing risk of bias”tool recommended by Cochrane Collaboration for this assessment while two used other tools. The assessment results of AMSTAR tool showed: the scores of four SRs were ≥9, and the others were ≤8. GRADE results showed: the quality of the evidence of 20 outcomes was low or very low, 10 outcomes was moderate and two outcomes was high. Conclusion Moderate quality evidence shows that febuxostat is beneficial in achieving target serum uric acid levels when compares to allopurinol, and high quality evidence shows the incidence of gout flares is not significantly different between the two groups. High quality evidence also shows that the safety of febuxostat is better than allopurinol. Evidence of SRs is still insufficient to support the effectiveness and safety of other urate-lowering drugs. We expect that more scientific and rigorous researches will be performed in the future, then more high quality evidence will be produced to fill relevant gaps.

关键词: 痛风; 降尿酸治疗; 系统评价再评价; AMSTAR 工具; GRADE 分级

Key words: Gout; Treatment of acute flares; Overview of systematic review; AMSTAR tool; GRADE