Gu Ting, Zheng Cai-Ying, Deng Yan-Qin, Yang Xiao-Feng, Bao Wei-Min, Tang Ying-Mei
Department of Gastroenterology, Second Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, Yunnan, China.
Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
J Clin Transl Hepatol. 2024 Aug 28;12(8):739-749. doi: 10.14218/JCTH.2023.00508. Epub 2024 Jun 28.
The hepatitis E virus (HEV) is a zoonotic disease, and infection with HEV in humans primarily causes acute infections and can progress to chronic manifestation in immunocompromised individuals. Over the past decade, guidelines for diagnosing and treating HEV infection have been developed. This study aimed to systematically assess the quality of current guidelines for diagnosing and treating HEV infection, and we analyzed the differences in guideline quality and primary recommendations and explored possible reasons for these differences.
Guidelines published between 2013 and 2022 were searched, and studies were identified using selection criteria. The study assessed the quality of the included guidelines using the Appraisal of Guidelines for Research and Evaluation tool, extracted the primary recommendations in the guidelines, determined the highest level of evidence supporting the recommendations, and reclassified the evidence using the Oxford Centre for Evidence-Based Medicine grading system.
Seven guidelines were included in the final analysis. The quality of the guidelines varied widely. The discrepancies may have been caused by the lack of external experts, the failure to consider influencing factors in guideline application, and the lack of consideration of the public's opinion. Analysis of the heterogeneity in primary recommendations revealed differences in algorithms for managing chronic HEV infection, the dosage of ribavirin, and a low level of evidence supporting the primary recommendations.
Guideline quality and primary recommendations vary considerably. Refinement by guideline developers and researchers would facilitate updating and applying guidelines for diagnosing and treating HEV infection.
戊型肝炎病毒（HEV）是一种人畜共患病，人类感染HEV主要引起急性感染，在免疫功能低下的个体中可进展为慢性表现。在过去十年中，已制定了戊型肝炎病毒感染的诊断和治疗指南。本研究旨在系统评估当前戊型肝炎病毒感染诊断和治疗指南的质量，分析指南质量和主要推荐意见的差异，并探讨这些差异的可能原因。
检索2013年至2022年间发表的指南，并根据选择标准确定研究。该研究使用《研究与评价指南评估工具》评估纳入指南的质量，提取指南中的主要推荐意见，确定支持这些推荐意见的最高证据水平，并使用牛津循证医学中心分级系统对证据进行重新分类。
最终分析纳入了七项指南。指南质量差异很大。差异可能是由于缺乏外部专家、未考虑指南应用中的影响因素以及未考虑公众意见所致。对主要推荐意见异质性的分析揭示了慢性戊型肝炎病毒感染管理算法、利巴韦林剂量以及支持主要推荐意见的证据水平较低方面的差异。
指南质量和主要推荐意见差异很大。指南制定者和研究人员进行完善将有助于更新和应用戊型肝炎病毒感染的诊断和治疗指南。
