针灸治疗多囊卵巢综合征的系统评价的质量评价
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摘要
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系统结果显示,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证据分级较低。因此,今后在设计临床试验时应严格规范试验设计,采用高质量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。
Objectives To evaluate the methodological bias and the reliability of the conclusions of systematic reviews on acupuncture for polycystic ovary syndrome. Methods We comprehensively searched PubMed, EMbase, The Cochrane Library, CBM, CNKI and WanFang Data to collect systematic reviews on acupuncture for polycystic ovary syndrome from the establishment time of databases to January 5~(th), 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 the 11 items, most problems occurred in 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". Conclusions Current acupuncture treatment of polycystic ovary syndrome has a certain effect, however, the quality of evidence is low. Thus, physicians should apply the evidence to make decision on acupuncture for polycystic ovary syndrome with caution in clinical practice and consider the actual situation,combined with the patient's value preferences and economic factors.
Objectives To evaluate the methodological bias and the reliability of the conclusions of systematic reviews on acupuncture for polycystic ovary syndrome. Methods We comprehensively searched PubMed, EMbase, The Cochrane Library, CBM, CNKI and WanFang Data to collect systematic reviews on acupuncture for polycystic ovary syndrome from the establishment time of databases to January 5~(th), 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 the 11 items, most problems occurred in 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". Conclusions Current acupuncture treatment of polycystic ovary syndrome has a certain effect, however, the quality of evidence is low. Thus, physicians should apply the evidence to make decision on acupuncture for polycystic ovary syndrome with caution in clinical practice and consider the actual situation,combined with the patient's value preferences and economic factors.
引文
1Homburg R. Management of infertility and prevention of ovarian hyperstimulation in women with polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol, 2004, 18(5):773-788.
2 Lizneva D, Suturina L, Walker W, et al. Criteria, prevalence, and phenotypes of polycystic ovary syndrome. Fertil Steril, 2016,106(1):6-15.
3Teede H, Deeks A, Moran L. Polycystic ovary syndrome:a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Med, 2010, 8:41.
4 Jedel E, Waern M, Gustafson D, et al. Anxiety and depression symptoms in women with polycystic ovary syndrome compared with controls matched for body mass index. Human Reprod, 2010,25(2):450-456.
5Petta S, Ciresi A, Bianco J, et al. Insulin resistance and hyperandrogenism drive steatosis and fibrosis risk in young females with PCOS. Plos One, 2017, 12(11):e0186136.
6 Ashrafi M, Sheikhan F, Arabipoor A, et al. Gestational diabetes mellitus and metabolic disorder among the different phenotypes of polycystic ovary syndrome. Oman Med J, 2017, 32(3):214-220.
7Yu H, Chen H, Rao D, et al. Association between polycystic ovary syndrome and the risk of pregnancy complications:a PRISMAcompliant systematic review and meta-analysis. Medicine(Baltimore), 2016, 95(51):e4863.
8 Costello MF, Misso ML, Wong J, et al. The treatment of infertility in polycystic ovary syndrome:a brief update. Aust N Z J Obstet Gynaecol, 2012, 52(4):400-403.
9Cheragh E, Soleimani Mehranjani M, Shariatzadeh SMA, et al. NAcetylcysteine compared to metformin, improves the expression profile of growth differentiation factor-9 and receptor tyrosine kinase c-kit in the oocytes of patients with polycystic ovarian syndrome. Int J Fertil Steril, 2018, 11(4):270-278.
10 de Medeiros SF. Risks, benefits size and clinical implications of combined oral contraceptive use in women with polycystic ovary syndrome. Reprod Biol Endocrinol, 2017, 15(1):93.
11Johansson J, Stener-Victorin E. Polycystic ovary syndrome:effect and mechanisms of acupuncture for ovulation induction. Evid Based Complement Alternat Med, 2013, 2013:762615.
12 高金金,侯丽辉,李妍.多囊卵巢综合征的病理机制和针刺治疗机制的研究进展.中华中医药学刊, 2016, 34(2):320-323.
13熊俊,陈日新.系统评价/Meta分析方法学质量的评价工具AMSTAR.中国循证医学杂志, 2011, 11(9):1084-1089.
14Guyatt GH, Oxman AD, Vist GE, et al. GRADE:an emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 2008, 336(7650):924-926.
15 任丽娜,郭丽红,马文珠,等.针刺治疗多囊卵巢综合征:随机对照试验的系统综述和Meta分析.针刺研究, 2014, 39(3):238-246.
16马红.针刺治疗多囊卵巢综合征及其改善焦虑状态的研究.广东:广州中医药大学, 2014.
17 朱怡,沈卫东.针灸与西药治疗多囊卵巢综合征疗效比较的Meta分析.中医学报, 2014, 29(11):1649-1652.
18林可.针灸治疗多囊卵巢综合征的Meta分析.广东:广州中医药大学, 2013.
19 张戈.针灸治疗多囊卵巢综合征所致不孕的荟萃分析.哈尔滨:黑龙江中医药大学, 2011.
20李瑞根,王威,许晓蓓,等.针药并用治疗多囊卵巢综合征疗效系统综述与Meta分析.实用中医内科杂志, 2016, 30(1):1-5.
21 钱丽欢.针灸治疗多囊卵巢综合征的现代中文期刊文献研究.广东:广州中医药大学, 2016.
22Lim CE, Ng RW, Xu K, et al. Acupuncture for polycystic ovarian syndrome. Cochrane Database Syst Rev, 2016,(5):CD007689.
23 Jo J, Lee YJ, Lee H. Acupuncture for polycystic ovarian syndrome:a systematic review and meta-analysis. Medicine(Baltimore), 2017,96 (23):e7066.
24Qu F, Wu Y, Hu XY, et al. The effects of acupuncture on polycystic ovary syndrome:a systematic review and meta-analysis. Eur J Integr Med, 2016, 8(1):12-18.
25 余超超,马朝阳,熊袁,等.穴位埋线治疗多囊卵巢综合征的系统评价和Meta分析. WJAM, 2017, 27(4):41-51.
26Booth A, Clarke M, Ghersi D, et al. An international registry of systematic-reviews protocols. Lancet, 2011, 377(9760):108-109.
27 郭新峰,赖世隆,梁伟雄.中医药临床疗效评价中结局指标的选择与应用.广州中医药大学学报, 2002, 19(4):251-255.
28薛春芬,陈莲萍.多囊卵巢综合征的药物治疗进展.医学综述,2018, 24(1):144-149.
29 郭磊.不同药物预处理多囊卵巢综合征合并不孕患者的疗效及不良反应观察.吉林医学, 2017, 38(11):2095-2096.
30Lanham MS, Lebovic DI, Domino SE. Contemporary medical therapy for polycystic ovary syndrome. Int J Gynaecol Obstet,2006, 95(3):236-241.
2 Lizneva D, Suturina L, Walker W, et al. Criteria, prevalence, and phenotypes of polycystic ovary syndrome. Fertil Steril, 2016,106(1):6-15.
3Teede H, Deeks A, Moran L. Polycystic ovary syndrome:a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Med, 2010, 8:41.
4 Jedel E, Waern M, Gustafson D, et al. Anxiety and depression symptoms in women with polycystic ovary syndrome compared with controls matched for body mass index. Human Reprod, 2010,25(2):450-456.
5Petta S, Ciresi A, Bianco J, et al. Insulin resistance and hyperandrogenism drive steatosis and fibrosis risk in young females with PCOS. Plos One, 2017, 12(11):e0186136.
6 Ashrafi M, Sheikhan F, Arabipoor A, et al. Gestational diabetes mellitus and metabolic disorder among the different phenotypes of polycystic ovary syndrome. Oman Med J, 2017, 32(3):214-220.
7Yu H, Chen H, Rao D, et al. Association between polycystic ovary syndrome and the risk of pregnancy complications:a PRISMAcompliant systematic review and meta-analysis. Medicine(Baltimore), 2016, 95(51):e4863.
8 Costello MF, Misso ML, Wong J, et al. The treatment of infertility in polycystic ovary syndrome:a brief update. Aust N Z J Obstet Gynaecol, 2012, 52(4):400-403.
9Cheragh E, Soleimani Mehranjani M, Shariatzadeh SMA, et al. NAcetylcysteine compared to metformin, improves the expression profile of growth differentiation factor-9 and receptor tyrosine kinase c-kit in the oocytes of patients with polycystic ovarian syndrome. Int J Fertil Steril, 2018, 11(4):270-278.
10 de Medeiros SF. Risks, benefits size and clinical implications of combined oral contraceptive use in women with polycystic ovary syndrome. Reprod Biol Endocrinol, 2017, 15(1):93.
11Johansson J, Stener-Victorin E. Polycystic ovary syndrome:effect and mechanisms of acupuncture for ovulation induction. Evid Based Complement Alternat Med, 2013, 2013:762615.
12 高金金,侯丽辉,李妍.多囊卵巢综合征的病理机制和针刺治疗机制的研究进展.中华中医药学刊, 2016, 34(2):320-323.
13熊俊,陈日新.系统评价/Meta分析方法学质量的评价工具AMSTAR.中国循证医学杂志, 2011, 11(9):1084-1089.
14Guyatt GH, Oxman AD, Vist GE, et al. GRADE:an emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 2008, 336(7650):924-926.
15 任丽娜,郭丽红,马文珠,等.针刺治疗多囊卵巢综合征:随机对照试验的系统综述和Meta分析.针刺研究, 2014, 39(3):238-246.
16马红.针刺治疗多囊卵巢综合征及其改善焦虑状态的研究.广东:广州中医药大学, 2014.
17 朱怡,沈卫东.针灸与西药治疗多囊卵巢综合征疗效比较的Meta分析.中医学报, 2014, 29(11):1649-1652.
18林可.针灸治疗多囊卵巢综合征的Meta分析.广东:广州中医药大学, 2013.
19 张戈.针灸治疗多囊卵巢综合征所致不孕的荟萃分析.哈尔滨:黑龙江中医药大学, 2011.
20李瑞根,王威,许晓蓓,等.针药并用治疗多囊卵巢综合征疗效系统综述与Meta分析.实用中医内科杂志, 2016, 30(1):1-5.
21 钱丽欢.针灸治疗多囊卵巢综合征的现代中文期刊文献研究.广东:广州中医药大学, 2016.
22Lim CE, Ng RW, Xu K, et al. Acupuncture for polycystic ovarian syndrome. Cochrane Database Syst Rev, 2016,(5):CD007689.
23 Jo J, Lee YJ, Lee H. Acupuncture for polycystic ovarian syndrome:a systematic review and meta-analysis. Medicine(Baltimore), 2017,96 (23):e7066.
24Qu F, Wu Y, Hu XY, et al. The effects of acupuncture on polycystic ovary syndrome:a systematic review and meta-analysis. Eur J Integr Med, 2016, 8(1):12-18.
25 余超超,马朝阳,熊袁,等.穴位埋线治疗多囊卵巢综合征的系统评价和Meta分析. WJAM, 2017, 27(4):41-51.
26Booth A, Clarke M, Ghersi D, et al. An international registry of systematic-reviews protocols. Lancet, 2011, 377(9760):108-109.
27 郭新峰,赖世隆,梁伟雄.中医药临床疗效评价中结局指标的选择与应用.广州中医药大学学报, 2002, 19(4):251-255.
28薛春芬,陈莲萍.多囊卵巢综合征的药物治疗进展.医学综述,2018, 24(1):144-149.
29 郭磊.不同药物预处理多囊卵巢综合征合并不孕患者的疗效及不良反应观察.吉林医学, 2017, 38(11):2095-2096.
30Lanham MS, Lebovic DI, Domino SE. Contemporary medical therapy for polycystic ovary syndrome. Int J Gynaecol Obstet,2006, 95(3):236-241.