构建适合中医药特征的临床证据评价体系
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摘要
2015年中华中医药学会组织中医药临床实践指南的制定工作,提出应用GRADE系统方法学作为构建中医临床证据体系的主要方法学,并在此基础上完成了相关一系列临床实践指南的制定工作。文章以实际工作为线索,发现在制定治未病实践指南过程中存在中医药临床证据体系构建的特殊性,以穴位贴敷干预哮病治未病实践指南为例,阐述应用GRADE系统方法学构建中医药临床证据体系,存在中医药的特殊性,应当建立适合中医药特征的临床证据评价体系,建议该系统包括将GRADE系统方法学得出的结论作为前提,将名医经验即专家共识以及古籍经典作为证据体系的重要组成部分,将科学方法获得的专家共识作为补充证据,最后加上中医特色结局指标体系。
When China Association of Chinese Medicine organized develop work of Chinese medicine clinical practice guidelines in 2015, they proposed used the GRADE systematic methodology as the main method of building TCM clinical evidence system and based on this basis to complete a series of clinical practice guidelines. Taking the practical work as a clue, the article found exist particularity of building clinical evidence system in the process of developing clinical practice guideline for preventive treatment of disease. Taking the practice guideline of treating wheezing by plaster acupoint for preventive treatment of disease as example, the article explained the application of GRADE system methodology to build Chinese medicine clinical evidence system exists particularity of TCM, and should establish clinical evidence evaluation system suitable for the characteristics of TCM. The proposed system including the conclusions by GRADE system methodology as a prerequisite, followed by the experience of experts that expert consensus and ancient books classic as an important part of the evidence system, once again scientific methods to obtain expert consensus as a supplemental evidence, and finally with the outcome index system in characteristics of TCM.
When China Association of Chinese Medicine organized develop work of Chinese medicine clinical practice guidelines in 2015, they proposed used the GRADE systematic methodology as the main method of building TCM clinical evidence system and based on this basis to complete a series of clinical practice guidelines. Taking the practical work as a clue, the article found exist particularity of building clinical evidence system in the process of developing clinical practice guideline for preventive treatment of disease. Taking the practice guideline of treating wheezing by plaster acupoint for preventive treatment of disease as example, the article explained the application of GRADE system methodology to build Chinese medicine clinical evidence system exists particularity of TCM, and should establish clinical evidence evaluation system suitable for the characteristics of TCM. The proposed system including the conclusions by GRADE system methodology as a prerequisite, followed by the experience of experts that expert consensus and ancient books classic as an important part of the evidence system, once again scientific methods to obtain expert consensus as a supplemental evidence, and finally with the outcome index system in characteristics of TCM.
引文
[1]陈耀龙,姚亮,杜亮,等.GRADE在诊断准确性试验系统评价中应用的原理、方法、挑战及发展趋势.中国循证医学杂志,2014,14(11):1402-1406
[2]姚亮,陈耀龙,杜亮,等.GRADE在诊断准确性试验系统评价中应用的实例解析.中国循证医学杂志,2014,14(11):1407-1412
[3]谭惠娟,兰颖,吴扶生,等.基于GRADE系统的耳穴贴压治疗原发性失眠系统评价.中国针灸,2014,34(7):726-730
[4]宇文亚,韩学杰,刘孟宇,等.中医临床实践指南评价的思路和方法.中国医学创新,2014,11(3):88-89
[5]陈昊,王艳,胡轩铭,等.GRADEpro GDT在干预性系统评价证据质量分级中的应用.中国循证医学杂志,2015,15(5):600-606
[6]沈毅.如何使用GRADE推荐分级方法制订指南.2014浙江省临床流行病学与循证医学学术年会论文汇编,2014:14
[7]2012兰州·国际临床实践指南暨GRADE研讨会在兰州大学召开.中国循证医学杂志,2012,12(6):726
[8]李慧,陈耀龙,谢秀丽,等.中医(中西医结合)临床实践指南制修订方法--证据质量分级.中华中医药杂志,2016,31(7):2652-2656.
[9]史楠楠,韩学杰,宇文亚,等.临床实践指南适用性改编方法及对中医临床实践指南的启示.中华中医药杂志,2014,29(10):3166-3169
[10]韩学杰,连智华,刘兴方,等.基于循证医学的冠心病心绞痛中医实践指南释义.中华中医药杂志,2014,29(4):978-981
[11]汪受传,虞舜,赵霞,等.循证性中医临床诊疗指南研究的现状与策略.中华中医药杂志,2012,27(11):2759-2763
[12]李红,程英武.德尔菲法在中医学中的应用研究.湖北中医杂志,2013,35(3):27-28
[13]陈昊,王艳,陈耀龙,等.从GRADE系统方法学看中医药临床证据体系的构建.中华中医药杂志,2017,32(1):25-28
[14]李慧,陈耀龙,谢秀丽,等.中医(中西医结合)临床实践指南制修订方法-证据质量分级.中华中医药杂志,2016,31(7):2652-2656
[15]曾宪涛,冷卫东,李胜,等.如何正确理解及使用GRADE系统.中国循证医学杂志,2011,11(9):985-990
[2]姚亮,陈耀龙,杜亮,等.GRADE在诊断准确性试验系统评价中应用的实例解析.中国循证医学杂志,2014,14(11):1407-1412
[3]谭惠娟,兰颖,吴扶生,等.基于GRADE系统的耳穴贴压治疗原发性失眠系统评价.中国针灸,2014,34(7):726-730
[4]宇文亚,韩学杰,刘孟宇,等.中医临床实践指南评价的思路和方法.中国医学创新,2014,11(3):88-89
[5]陈昊,王艳,胡轩铭,等.GRADEpro GDT在干预性系统评价证据质量分级中的应用.中国循证医学杂志,2015,15(5):600-606
[6]沈毅.如何使用GRADE推荐分级方法制订指南.2014浙江省临床流行病学与循证医学学术年会论文汇编,2014:14
[7]2012兰州·国际临床实践指南暨GRADE研讨会在兰州大学召开.中国循证医学杂志,2012,12(6):726
[8]李慧,陈耀龙,谢秀丽,等.中医(中西医结合)临床实践指南制修订方法--证据质量分级.中华中医药杂志,2016,31(7):2652-2656.
[9]史楠楠,韩学杰,宇文亚,等.临床实践指南适用性改编方法及对中医临床实践指南的启示.中华中医药杂志,2014,29(10):3166-3169
[10]韩学杰,连智华,刘兴方,等.基于循证医学的冠心病心绞痛中医实践指南释义.中华中医药杂志,2014,29(4):978-981
[11]汪受传,虞舜,赵霞,等.循证性中医临床诊疗指南研究的现状与策略.中华中医药杂志,2012,27(11):2759-2763
[12]李红,程英武.德尔菲法在中医学中的应用研究.湖北中医杂志,2013,35(3):27-28
[13]陈昊,王艳,陈耀龙,等.从GRADE系统方法学看中医药临床证据体系的构建.中华中医药杂志,2017,32(1):25-28
[14]李慧,陈耀龙,谢秀丽,等.中医(中西医结合)临床实践指南制修订方法-证据质量分级.中华中医药杂志,2016,31(7):2652-2656
[15]曾宪涛,冷卫东,李胜,等.如何正确理解及使用GRADE系统.中国循证医学杂志,2011,11(9):985-990