医学研究中证据分级和推荐强度演进.pdf

• 论  著  二次研究 中国循证医学杂志, 2008, 8(2): 127 ～133 医学研究中证据分级和推荐强度的演进 1 1 * 2 1 1 1 陈耀龙  李幼平   杜  亮  王  莉  文  进  杨晓妍  1.四川大学华西医院循证医学与临床流行病学教研室（成都 610041 ）； 2. 四川大学华西医院中国循证医学杂志编辑部（成都610041 ） 摘要 本文系统分析了 1979~2007 年间50 个主要组织和机构的证据分级标准及推荐意见强度，遴选出最具代 表性的5 个国家和国际组织的 11 个标准，并从分级特点、影响范围、使用领域等角度将其分为三个发展阶段。目前 医学领域的标准已趋于成熟，并逐步统一。未来的挑战是在管理、教育、基础研究、经济学、社会学、法学等非医非 药领域引入证据分类分级理念，研究制定符合循证医学思想，满足各领域研究和实践需要的高质量证据分类分级 标准和推荐意见强度，接受时间和实践的检验。 关键词 循证医学；证据分级；推荐强度 Evolution of Levels of Evidence and Strength of Recommendations in Medical Research 1 1 * 2 1 1 1 CHEN Yao-long , LI You-ping , DU Liang , WANG Li , WEN Jin , YANG Xiao-yan 1. Clinical Epidemiology and Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China; 2. Editorial Board of the Chinese Journal of Evidence Based Medicine, West China Hospital, Sichuan University, Chengdu 610041, China Abstract  A systematic literature search and a comparative study were conducted to investigate the evolution of the levels of evidence and strength of recommendations in medical research. Fifty systems were included from 1979 to 2007, and 11 of these, which came from five states or international organizations, were selected and divided into three stages according to their characteristics, sphere of influence and application fields. Ideas about levels of evidence and strength of recommendations are becoming mature in medical research. The challenge for the future is how to introduce evidence- based princi ples and develop the corresponding levels of evidence and strength of recommendations in the fields of management, education, basic medical sciences, economics, sociology