Abstract: Background The Grading of Recommendations, Assessment, Development and Evaluation（GRADE）approach is a seminal framework in the field of evidence-based medicine and continues to evolve. Therefore, timely synthesis of its latest methodological advances and practical applications are crucial for clarifying its developmental trajectory and guiding future directions. Objective This study aims to systematically summarize the GRADE approach to provide researchers and guideline developers with a comprehensive reference for keeping abreast of cutting-edge developments and applying advanced methods.Methods We conducted a systematic review of the GRADE Working Group's official website and related publications to summarize the organizational structure, series articles, publications, and current usage of GRADE. By compiling the main content of GRADE Guidance, Concept papers, Notes, and Core GRADE articles published between 2021 and 2025, as well as the evolution from the GRADE Handbook to the GRADE Book, we elucidated the latest methodological progress in GRADE. Results （1）GRADE organizational structure：Through the collaborative mechanisms of guidance groups, centers, networks, and project teams, GRADE achieves global knowledge co-creation and continuous updates. （2）GRADE series articles：To date, 42 GRADE Guidance articles, 9 GRADE Concept papers, and 6 GRADE Notes have been published, covering methodological deepening and expanded applications, such as systematic guidance for GRADE in diagnostic test accuracy studies, imprecision, inconsistency, network meta-analysis, and threshold setting. （3）GRADE Book and GRADE GPT：The GRADE Handbook has been upgraded to the modular and dynamically updated GRADE Book, and an AI-based assistant, GRADE GPT, has been introduced. （4）Core GRADE：The latest series of GRADE articles streamline the integration of core GRADE principles to enhance usability and consistency. （5）Practical application of GRADE：Although standards exist for evaluating the use of GRADE, structured assessment tools are still lacking, and current guideline adherence to GRADE varies. Conclusion This study systematically reviews the latest developments in the GRADE methodological framework, highlighting the core trend of evolution from foundational frameworks toward depth, refinement, and intelligence. The launch of the Core GRADE series marks a strategic effort to reconcile the growing complexity of the methodology with the need for practical accessibility, thereby promoting broader implementation. Current practice also indicates the need to focus on the effective implementation of GRADE methods in real-world settings.

Key words: GRADE approach, Certainty of evidence, Guidelines, Strength of recommendations, GRADE Guidance, Core GRADE, GRADE Book, GRADE GPT

摘要： 背景 推荐分级的评估、制订与评价（GRADE）方法是循证医学领域的里程碑式方法学体系，并处于持续演进之中。为此，及时梳理与总结其最新方法学进展与实践应用，对于明晰其发展脉络、指引未来方向至关重要。目的 本文旨在对此进行系统总结，以期为国内研究者与指南制订者把握前沿动态、应用先进方法提供全面参考。方法 通过系统检索GRADE工作组官网及其相关出版物，对其组织架构、系列文章及出版物以及GRADE使用现状进行系统梳理和总结。通过汇总2021—2025年GRADE Guidance、Concept及Notes以及Core GRADE系列文章的主要内容，及GRADE Handbook向GRADE Book的演进，阐述GRADE方法的最新进展。结果 （1）GRADE组织架构：GRADE通过指导小组、中心、网络及项目组协同机制，实现全球化知识共创与持续更新；（2）GRADE 系列文章：目前已发表的GRADE Guidance 42篇，GRADE Concept paper 9篇，GRADE Notes 6篇，其内容涵盖方法学的深化及应用场景扩展，如在诊断试验准确性研究的GRADE方法、不精确性、不一致性、网状Meta分析及阈值设定等领域提出了系统化指导；（3）GRADE Book与GRADE GPT：GRADE Handbook升级为模块化、动态更新的GRADE Book，并推出基于大语言模型的智能助手GRADE GPT；（4）Core GRADE：GRADE最新系列文章，以更简化的路径整合GRADE核心原理，提升可用性与一致性；（5）GRADE实践应用：已有评判GRADE使用的相关标准，但仍缺乏结构化的评估工具，当前指南对GRADE的依从情况参差不齐。结论 本研究系统梳理了GRADE方法学体系的最新进展，揭示了其从基础框架向深度、精细化、智能化演进的核心趋势。同时Core GRADE系列的推出，标志着GRADE正试图解决方法学日益复杂化与实际应用便捷性之间的矛盾，促进其更广泛的实践。GRADE的实践现状提示研究者需要关注GRADE方法在实践中的有效实施。

关键词: GRADE 方法, 证据确定性, 指南, 推荐强度, GRADE Guidance, Core GRADE, GRADE Book, GRADE GPT