CAJ | 학술논문

目的：系统评价儿童吉兰-巴雷综合征（G B S）的相关指南，为临床循证用药提供一定的参考。方法计算机检索PubMed、EMbase、CBM、万方数据、中国知网、维普网等中英文数据库中GBS相关指南；其次检索美国医疗保健与质量局（NGC）、国际指南数据库（GIN）、Trip等指南数据库以及各大医学会及行业机构网站包括美国疾病预防控制中心（CDC）、美国感染病学会（IDSA）、美国儿科学会（AAP）、世界卫生组织（WHO）、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。检索时限均为从建库或建网至2013年10月。由2位研究者按照纳入与排除标准独立筛选文献，并采用AGREEⅡ工具评价指南的质量，使用组内相关系数(ICC)进行评价员间一致性检验。结果最终纳入指南5篇，时间跨度从2003-2012年，5篇指南分别来自美国、欧洲和加拿大。纳入指南最终推荐均为B级，在AGREEⅡ各领域中“制定严谨性”与“清晰性”总体得分最高，而得分普遍较低的领域是“应用性”。血浆置换(PE)和静滴丙种球蛋白(IVIG)对于GBS的治疗均可获得较好的效果，但不建议两者联合应用，同时对于激素的使用也持否定的态度。结论儿童GBS治疗的选择，各指南推荐内容基本一致。循证指南中对证据级别和推荐强度的划分标准不一，有待进一步完善，同时指南地应用策略要进一步加强。
목적：계통평개인동길란-파뢰종합정（G B S）적상관지남，위림상순증용약제공일정적삼고。방법계산궤검색PubMed、EMbase、CBM、만방수거、중국지망、유보망등중영문수거고중GBS상관지남；기차검색미국의료보건여질량국（NGC）、국제지남수거고（GIN）、Trip등지남수거고이급각대의학회급행업궤구망참포괄미국질병예방공제중심（CDC）、미국감염병학회（IDSA）、미국인과학회（AAP）、세계위생조직（WHO）、중국위생화계화생육위원회망참、중국림상지남문고화중국림상지남협작망。검색시한균위종건고혹건망지2013년10월。유2위연구자안조납입여배제표준독립사선문헌，병채용AGREEⅡ공구평개지남적질량，사용조내상관계수(ICC)진행평개원간일치성검험。결과최종납입지남5편，시간과도종2003-2012년，5편지남분별래자미국、구주화가나대。납입지남최종추천균위B급，재AGREEⅡ각영역중“제정엄근성”여“청석성”총체득분최고，이득분보편교저적영역시“응용성”。혈장치환(PE)화정적병충구단백(IVIG)대우GBS적치료균가획득교호적효과，단불건의량자연합응용，동시대우격소적사용야지부정적태도。결론인동GBS치료적선택，각지남추천내용기본일치。순증지남중대증거급별화추천강도적화분표준불일，유대진일보완선，동시지남지응용책략요진일보가강。
Objective To systematic review the methodological quality of guidelines for Guillain-Barré syndrome (GBS) in children, to provide a reference for clinical evidence-based medicine. Methods Guidelines concerning GBS were electronically retrieved from PubMed, EMbase, CBM, Wanfang data, CNKI and Vip. The guide databases includes major medical institutions and industry sites such as NGC, GIN, TRIP , CDC, IDSA, AAP, WHO, Chinese Health and Family Planning Committee website, library of clinical guidelines China and Chinese clinical guidelines for collaboration. All the data were searched from inception of the database or network to Oct. 2013. Two reviews independently screened literature according to the inclusion and exclusion criteria, and assessed the quality of guideline using the AGREEⅡ. Intraclass correlation coefficient (ICC) was used to examine the conformance of the raters' evaluation scores. Results A total of 5 guidelines concerning GBS were included, with a time range from 2003 to 2012, and origins from USA, EU and Canada. The final recommendation levels of the 5 articles were level B. According to the AGREEⅡ, domain 3 and 4 showed the higher scores, and scores were generally low in domain 5. Plasma exchange (PE) and intravenous immuneglobulin (IVIG) showed positive effects on the treatment of GBS. But it was not recommended that combined PE and IVIG. Corticosteroids are also not recommended for GBS treatment. Conclusions The recommendations of medicines for GBS are basically consistent. However, the classification criteria of the levels of evidence and recommendation are still unconsistent and suboptimal. The guidelines on GBS should be improved in“Applicability”in future.