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马华萍，韩振蕴，常泽，等 . 血管性认知障碍指南质量评价［J］. 中国全科医学，2022，25（9）：1039-1046. ［www.
chinagp.net］
MA H P，HAN Z Y，CHANG Z，et al. Quality assessment of guidelines forvascular cognitive impairment using the
AGREE Ⅱ［J］. Chinese General Practice，2022，25（9）：1039-1046.

1
Quality Assessment of Guidelines forVascular Cognitive Impairment Using the AGREE Ⅱ MA Huaping ，HAN
1
2*
1
1
Zhenyun ，CHANG Ze ，WANG Yuchun ，HU Yuli ，ZHANG Dingding 3
1. Beijing University of Chinese Medicine，Beijing 100029，China
2.Shenzhen Hospital of Beijing University of Chinese Medicine，Shenzhen 518100，China
3.Binhai New District Hangu Hospital of Chinese Medicine，Tianjin 300480，China
*
Corresponding author：HAN Zhenyun，Chief physician，Professor；E-mail：tohanzhenyun@sina.com
【Abstract】 Background As the second primary type of cognitive impairment worldwide，vascular cognitive
impairment （VCI） is closely associated with cerebrovascular risks，which imposes a heavy burden on the society and families.
Early diagnosis and treatment are important for intervening and reversing VCI. And formulating high-quality clinical guidelines
is an effective way to improve diagnosis and treatment levels of VCI. Objective To assess the quality of guidelines for VCI，
aiming at offering support for making clinical decisions for VCI. Methods From August to November 2021，we searched
literature databases and websites in China and abroad to identify guidelines for VCI，and assessed them using the Appraisal of
Guidelines for Research & Evaluation（AGREE）Ⅱ . Results A total of 18 guidelines were enrolled，12 of which are Chinese
guidelines and 6 are foreign guidelines；9 of which are evidence-based guidelines，and the other 9 are not. The intraclass
correlation coefficient was 0.935，indicating a high degree of agreement between raters. The overall quality of these guidelines was
relatively low，since in the six domains，only the average score of Clarity of Presentation was greater than 60%（64.04%），
and the average scores of Scope and Purpose （52.31%）and Editorial Independence （42.01%） were between 30% and 60%，
and those for other three domains，Stakeholder Involvement（27.24%），Rigor of Development（20.05%）and Applicability
（13.83%），were all less than 30%. The grade of recommendation for 6 guidelines was B，and that for other 12 guidelines was C.
Conclusion The overall quality of the included guidelines was rated relatively low，especially their average score for each of the
three domains，Stakeholder Involvement，Rigor of Development，and Applicability，was below the average level. It is suggested
to enhance the quality of VCI guidelines via improving the details of guidelines strictly under the evidence-based principle.
【Key words】 Cognition disorders；Dementia，vascular；Guidebook；Quality assessment；The Appraisal of
Guidelines for Research & Evaluation Ⅱ

血 管 性 认 知 障 碍（vascular cognitive impairment， 干预性和可逆转性，因此 VCI 的早期诊断及治疗逐渐成
VCI）是指由脑血管病及相关危险因素引起的从非痴 为认知障碍领域研究的重点和热点 ［6-7］ 。
呆 性 血 管 性 认 知 障 碍（vascular cognitive impairment 面对日益增高的患病率、沉重的医疗负担、复杂的
nodementia，VCIND） 发 展 到 血 管 性 痴 呆（vascular 医疗服务环境以及 VCI 病情的复杂性等问题，仅靠专科
dementia，VaD）的一类综合征，以认知障碍、学习能 医生进行 VCI 患者的识别、筛查和诊疗远远不够，因
力下降、记忆力减退为主要临床表现 ［1］ 。VCI 被认为 此基层和专科医疗机构共同协作尤为重要。为提高各级
是一个“总括性术语”，包括由于不同病因的脑血管疾 医疗机构临床诊疗水平，各个国家相继出台了 VCI 相
病而导致的多种认知障碍，如大面积或关键部位脑梗 关指南。而高质量的指南对医务工作者的决策具有重要
死、皮质下缺血、多发性脑梗死、边缘带缺血和脑出血 意义 ［8］ 。因此本文采用临床指南研究与评估系统（The
（特别是大出血及多发皮质和 / 或皮质下微出血） ［2］ 。 Appraisal of Guidelines for Research & Evaluation Ⅱ，
因此，VCI 包括任何程度的认知障碍，从单一认知领 AGREE Ⅱ） ［9］ 评价自 2016 年以来的 VCI 相关指南，
域的损伤（轻度 VCI）到显性 VaD 或混合性痴呆（即 以期鉴别出高质量的指南，为 VCI 的临床决策提供参考。
血管性和退行性混合性痴呆） ［3］ 。VCI 被认为是继阿 1 资料与方法
尔茨海默病（Alzheimer disease，AD）之后的第二大最 1.1 检 索 策 略 2021 年 8—11 月， 计 算 机 检 索
常见的痴呆症类型疾病，AD 患者数占痴呆患者总数的 PubMed、中国知网（CNKI）、万方数据知识服务平台、
15%~20% ［4］ 。国内流行病学研究显示，中国 65 岁人 维普网（VIP）、中国生物医学文献服务系统（CBM）、
群中 VCI 患病率约为 8.7% ［5］ 。有研究表明 VCI 具有可 世界卫生组织（WHO）、国际指南联盟（GIN）、美国