不孕症临床指南的系统评价_《中国循证医学杂志》

作者：

崔世超 ^1,2 , 侯海燕 ¹ , 李幼平 ³ ,  陈亚琼 ¹ , 兰晓霞 ⁴

1. 天津武警后勤学院附属医院妇产科（天津 300162）；2. 惠州市中医医院妇产科（惠州 516001）；3. 四川大学华西医院中国循证医学中心（成都 610041）；4. 天津武警后勤学院流行病学与统计学教研室（天津 300162）;

关键词：

不孕症指南 AGREE Ⅱ 系统评价

DOI：

10.7507/1672-2531.20130166

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　系统评价不孕症临床指南，以期为临床使用提供参考。
方法　计算机检索PubMed、EMbase、CBM、WanFang Data、CNKI，检索时限均为从建库至2013年2月。其次检索GIN指南数据库、各指南制定组织网站（NGC、NICE、SIGN、NZGG、SOGC等）及各大医学会网站（IFFS、FIGO、ESHRE、NFOG、RCOG、ASRM、ACOG等）。中文指南网站包括中国卫生和计划生育委员会网站、中国临床指南文库和中国临床指南协作网等。由2位研究者按照纳入与排除标准独立筛选文献，并采用AGREE Ⅱ工具评价指南的制定和报告质量。
结果　① 最终纳入16篇指南，制定时间跨度1998～2012年。其中美国10篇，英国3篇，欧洲1篇，加拿大1篇，欧美合作1篇。② 纳入指南在AGREE Ⅱ各领域得分高低依次为：清晰性、范围和目的、参与人员、应用性、制定的严谨性及编辑的独立性。16篇指南总体质量不高，其推荐级别为A级5篇，B级8篇，C级3篇。③ 纳入指南中有4篇为循证指南，其在制定的严谨性上得分居前三。④ 各指南推荐意见较为一致。⑤ 我国尚无不孕症临床指南。
结论　① 今后不孕症临床指南在制定的严谨性和应用性上要加强，注意申明利益冲突。② 提倡采用循证医学方法制定指南，使用最佳证据。③ 我国要建立国家性或如ASRM等的组织，循证制定自己的中西医治疗不孕症指南，以规范诊疗。④ AGREE Ⅱ在对指南的总体评价上应给出建议的临界标准。

引用本文： 崔世超,侯海燕,李幼平,陈亚琼,兰晓霞. 不孕症临床指南的系统评价. 中国循证医学杂志, 2013, 13(8): 947-954. doi: 10.7507/1672-2531.20130166 复制

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.	侯丽艳. 我国三省不孕症的流行病学研究. 北京协和医学院博士研究生学位论文. 2011: 43-44.
3.	郑晓樱, 邱月. 中国不孕症疾病经济负担分析. 中国公共卫生, 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.	陈尹, 胡世莲, 李幼平, 等. 全球药物干预治疗单纯性高血压指南的系统评价. 中国循证医学杂志, 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. 侯丽艳. 我国三省不孕症的流行病学研究. 北京协和医学院博士研究生学位论文. 2011: 43-44.
3. 郑晓樱, 邱月. 中国不孕症疾病经济负担分析. 中国公共卫生, 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. 陈尹, 胡世莲, 李幼平, 等. 全球药物干预治疗单纯性高血压指南的系统评价. 中国循证医学杂志, 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.

《中国循证医学杂志》

不孕症临床指南的系统评价

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《中国循证医学杂志》

不孕症临床指南的系统评价

摘要 全文 图表 视频 参考文献 施引文献 补充材料

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