不孕癥臨床指南的系統評價_《中國循證醫學雜志》

作者：

崔世超 ^1,2 , 侯海燕 ¹ , 李幼平 ³ ,  陳亞瓊 ¹ , 蘭曉霞 ⁴

1. 天津武警后勤學院附屬醫院婦產科（天津 300162）；2. 惠州市中醫醫院婦產科（惠州 516001）；3. 四川大學華西醫院中國循證醫學中心（成都 610041）；4. 天津武警后勤學院流行病學與統計學教研室（天津 300162）;

關鍵詞：

不孕癥指南 AGREE Ⅱ 系統評價

DOI：

10.7507/1672-2531.20130166

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目的　系統評價不孕癥臨床指南，以期為臨床使用提供參考。
方法　計算機檢索PubMed、EMbase、CBM、WanFang Data、CNKI，檢索時限均為從建庫至2013年2月。其次檢索GIN指南數據庫、各指南制定組織網站（NGC、NICE、SIGN、NZGG、SOGC等）及各大醫學會網站（IFFS、FIGO、ESHRE、NFOG、RCOG、ASRM、ACOG等）。中文指南網站包括中國衛生和計劃生育委員會網站、中國臨床指南文庫和中國臨床指南協作網等。由2位研究者按照納入與排除標準獨立篩選文獻，并采用AGREE Ⅱ工具評價指南的制定和報告質量。
結果　① 最終納入16篇指南，制定時間跨度1998～2012年。其中美國10篇，英國3篇，歐洲1篇，加拿大1篇，歐美合作1篇。② 納入指南在AGREE Ⅱ各領域得分高低依次為：清晰性、范圍和目的、參與人員、應用性、制定的嚴謹性及編輯的獨立性。16篇指南總體質量不高，其推薦級別為A級5篇，B級8篇，C級3篇。③ 納入指南中有4篇為循證指南，其在制定的嚴謹性上得分居前三。④ 各指南推薦意見較為一致。⑤ 我國尚無不孕癥臨床指南。
結論　① 今后不孕癥臨床指南在制定的嚴謹性和應用性上要加強，注意申明利益沖突。② 提倡采用循證醫學方法制定指南，使用最佳證據。③ 我國要建立國家性或如ASRM等的組織，循證制定自己的中西醫治療不孕癥指南，以規范診療。④ AGREE Ⅱ在對指南的總體評價上應給出建議的臨界標準。

引用本文： 崔世超,侯海燕,李幼平,陳亞瓊,蘭曉霞. 不孕癥臨床指南的系統評價. 中國循證醫學雜志, 2013, 13(8): 947-954. doi: 10.7507/1672-2531.20130166 復制

1.	Mascarenhas MN, Flaxman SR, Boerma T, et al. National, Regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys. PLoS Med, 2012, 9(12): e1001356.
2.	侯麗艷. 我國三省不孕癥的流行病學研究. 北京協和醫學院博士研究生學位論文. 2011: 43-44.
3.	鄭曉櫻, 邱月. 中國不孕癥疾病經濟負擔分析. 中國公共衛生, 2012, 28(3): 257-260.
4.	Klemetti R, Raitanen J, Sihvo S, et al. Infertility, mental disorders and well-being–a nationwide survey. Acta Obstet Gynecol Scand, 2010, 89(5): 677-682.
5.	IOM (Institute of Medicine). Clinical Practice Guidelines We Can Trust. Washington, DC: The National Academies Press, 2011.
6.	Shaneyfelt TM, Mayo-Smith MF, Rothwangl J. Are guidelines following guidelines? The methodological quality of clinical practice guidelines in the peer-reviewed medical literature. JAMA, 1999, 281(20): 1900-1905.
7.	Brouwers M, Kho ME, Browman GP, et al. AGREE II: Advancing guideline development, reporting and evaluation in healthcare. Can Med Assoc J, 2010, 182(19): 839-842.
8.	陳尹, 胡世蓮, 李幼平, 等. 全球藥物干預治療單純性高血壓指南的系統評價. 中國循證醫學雜志, 2012, 12(10): 1180-1194.
9.	The Practice Committee of the American Society for Reproductive Medicine. Diagnostic evaluation of the infertile female: a committee opinion. Fertil Steril, 2012, 98(2): 294-301.
10.	The Practice Committee of the American Society for Reproductive Medicine. Committee opinion: role of tubal surgery in the era of assisted reproductive technology. Fertil Steril, 2012, 97(3): 539-545.
11.	The Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility: a committee opinion. Fertil Steril, 2012, 98(3): 591-598.
12.	The Practice Committee of the American Society for Reproductive. Optimizing natural fertility. Fertil Steril, 2008, 90(5 Suppl): 1-6.
13.	The Practice Committee of the American Society for Reproductive. Progesterone supplementation during the luteal phase and in early pregnancy in the treatment of infertility: an educational bulletin. Fertil Steril, 2008, 90(5 Suppl): 150-153.
14.	The Practice Committee of the American Society for Reproductive Medicine. Smoking and infertility. Fertil Steril, 2008, 90(5 Suppl): 254-259.
15.	The Practice Committee of the American Society for Reproductive Medicine. Age-related fertility decline: a committee opinion. Fertil Steril, 2008, 90(5 Suppl): 154-155.
16.	The Practice Committee of the American Society for Reproductive Medicine. Effectiveness and treatment for unexplained infertility. Fertil Steril, 2006, 86(4 Suppl): 111-114.
17.	The Practice Committee of the American Society for Reproductive Medicine. Aging and infertility in women. Fertil Steril, 2006, 86(4 Suppl): 248-252.
18.	Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Diagnostic laparoscopy in primary and secondary infertility. In: Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Diagnostic laparoscopy guidelines, 2007: 61-65.
19.	Royal College of Obstetricians and Gynaecologists. The role of bariatric surgery in the management of female fertility. Scientific Impact Paper No. 17. 2010: 1-7.
20.	Royal College of Obstetricians and Gynaecologists. Metformin therapy for the management of infertility in women with polycystic ovary syndrome. Scientific Impact Paper NO. 13. 2008: 1-5.
21.	National Collaborating Centre for Women’s and Children’s Health. Fertility: assessment and treatment for people with fertility problems. London: RCOG Press, 2004: 1-236.
22.	The Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Consensus on infertility treatment related to polycystic ovary syndrome. Human Reproduction, 2008, 23: 462-477.
23.	Boivin J, Appleton TC, Baetens P, et al. Guidelines for counseling in infertility: outline version. Hum Reprod, 2001, 16(6): 1301-1304.
24.	Reproductive Endocrinology and Infertility Committee, Family Physicians Advisory Committee, Maternal-Fetal Medicine Committee, et al. Advanced reproductive age and fertility. J Obstet Gynaecol Can, 2011, 33(11): 1165-1175.
25.	Burgers JS, Cluzeau FA, Hanna SE, et al. Towards evidence-based clinical practice: an international survey of 18 clinical guideline pro-grams. Int Qual Health Care, 2003, 15(1): 31-45.
26.	National Institute for Health and Clinical Excellence. The guidelines manual. London: National Institute for Health and Clinical Excellence, 2007. Available from: www.nice.org.uk.
27.	Wiener-Ogilvie S, Pinnock H, Huby G, et al. Do practices comply with key recommendations of the British Asthma Guideline? If not, why not? Prim Care Respir J, 2007, 16(6): 369-377.
28.	Chen YL, Yao L, Xiao XJ, et al. Quality assessment of clinical guidelines in China: 1993-2010. Chin Med J (Engl), 2012, 125(20): 3660-3664.

1. Mascarenhas MN, Flaxman SR, Boerma T, et al. National, Regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys. PLoS Med, 2012, 9(12): e1001356.
2. 侯麗艷. 我國三省不孕癥的流行病學研究. 北京協和醫學院博士研究生學位論文. 2011: 43-44.
3. 鄭曉櫻, 邱月. 中國不孕癥疾病經濟負擔分析. 中國公共衛生, 2012, 28(3): 257-260.
4. Klemetti R, Raitanen J, Sihvo S, et al. Infertility, mental disorders and well-being–a nationwide survey. Acta Obstet Gynecol Scand, 2010, 89(5): 677-682.
5. IOM (Institute of Medicine). Clinical Practice Guidelines We Can Trust. Washington, DC: The National Academies Press, 2011.
6. Shaneyfelt TM, Mayo-Smith MF, Rothwangl J. Are guidelines following guidelines? The methodological quality of clinical practice guidelines in the peer-reviewed medical literature. JAMA, 1999, 281(20): 1900-1905.
7. Brouwers M, Kho ME, Browman GP, et al. AGREE II: Advancing guideline development, reporting and evaluation in healthcare. Can Med Assoc J, 2010, 182(19): 839-842.
8. 陳尹, 胡世蓮, 李幼平, 等. 全球藥物干預治療單純性高血壓指南的系統評價. 中國循證醫學雜志, 2012, 12(10): 1180-1194.
9. The Practice Committee of the American Society for Reproductive Medicine. Diagnostic evaluation of the infertile female: a committee opinion. Fertil Steril, 2012, 98(2): 294-301.
10. The Practice Committee of the American Society for Reproductive Medicine. Committee opinion: role of tubal surgery in the era of assisted reproductive technology. Fertil Steril, 2012, 97(3): 539-545.
11. The Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility: a committee opinion. Fertil Steril, 2012, 98(3): 591-598.
12. The Practice Committee of the American Society for Reproductive. Optimizing natural fertility. Fertil Steril, 2008, 90(5 Suppl): 1-6.
13. The Practice Committee of the American Society for Reproductive. Progesterone supplementation during the luteal phase and in early pregnancy in the treatment of infertility: an educational bulletin. Fertil Steril, 2008, 90(5 Suppl): 150-153.
14. The Practice Committee of the American Society for Reproductive Medicine. Smoking and infertility. Fertil Steril, 2008, 90(5 Suppl): 254-259.
15. The Practice Committee of the American Society for Reproductive Medicine. Age-related fertility decline: a committee opinion. Fertil Steril, 2008, 90(5 Suppl): 154-155.
16. The Practice Committee of the American Society for Reproductive Medicine. Effectiveness and treatment for unexplained infertility. Fertil Steril, 2006, 86(4 Suppl): 111-114.
17. The Practice Committee of the American Society for Reproductive Medicine. Aging and infertility in women. Fertil Steril, 2006, 86(4 Suppl): 248-252.
18. Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Diagnostic laparoscopy in primary and secondary infertility. In: Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Diagnostic laparoscopy guidelines, 2007: 61-65.
19. Royal College of Obstetricians and Gynaecologists. The role of bariatric surgery in the management of female fertility. Scientific Impact Paper No. 17. 2010: 1-7.
20. Royal College of Obstetricians and Gynaecologists. Metformin therapy for the management of infertility in women with polycystic ovary syndrome. Scientific Impact Paper NO. 13. 2008: 1-5.
21. National Collaborating Centre for Women’s and Children’s Health. Fertility: assessment and treatment for people with fertility problems. London: RCOG Press, 2004: 1-236.
22. The Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Consensus on infertility treatment related to polycystic ovary syndrome. Human Reproduction, 2008, 23: 462-477.
23. Boivin J, Appleton TC, Baetens P, et al. Guidelines for counseling in infertility: outline version. Hum Reprod, 2001, 16(6): 1301-1304.
24. Reproductive Endocrinology and Infertility Committee, Family Physicians Advisory Committee, Maternal-Fetal Medicine Committee, et al. Advanced reproductive age and fertility. J Obstet Gynaecol Can, 2011, 33(11): 1165-1175.
25. Burgers JS, Cluzeau FA, Hanna SE, et al. Towards evidence-based clinical practice: an international survey of 18 clinical guideline pro-grams. Int Qual Health Care, 2003, 15(1): 31-45.
26. National Institute for Health and Clinical Excellence. The guidelines manual. London: National Institute for Health and Clinical Excellence, 2007. Available from: www.nice.org.uk.
27. Wiener-Ogilvie S, Pinnock H, Huby G, et al. Do practices comply with key recommendations of the British Asthma Guideline? If not, why not? Prim Care Respir J, 2007, 16(6): 369-377.
28. Chen YL, Yao L, Xiao XJ, et al. Quality assessment of clinical guidelines in China: 1993-2010. Chin Med J (Engl), 2012, 125(20): 3660-3664.

《中國循證醫學雜志》

不孕癥臨床指南的系統評價

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《中國循證醫學雜志》

不孕癥臨床指南的系統評價

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