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·指南·证据·

糖尿病患者甲病管理的最佳证据总结

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陈欢，侯朝铭 ，高静，柏丁兮，吴晨曦，王浩，游倩，鲜圆圆 扫描二维码
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【摘要】 背景 及时识别和正确处理甲病，对糖尿病患者足溃疡的预防意义重大，但目前临床医务人员对糖尿
病患者甲病的认识普遍不足，而我国尚缺乏有关糖尿病患者甲病管理的循证依据。目的 全面检索和分析糖尿病患者
甲病管理相关证据，并对最佳证据进行总结。方法 检索 2021-12-06 前在 BMJ Best Practice、UpToDate、世界卫生组
织网站、国际指南协作网、英国国家卫生与临床优化研究所网站、美国国立指南库、加拿大安大略护士学会、苏格兰
学院间指南网、新西兰指南协作网、医脉通、JBI 循证卫生保健中心、PubMed、Embase、CINAHL、中国知网、万方
数据知识服务平台中与糖尿病患者甲病管理相关的临床决策、指南、系统评价、专家共识，对其进行质量评价，依据
JBI 循证卫生保健中心证据预分级系统（2016 版）进行证据分级，对最佳证据进行汇总。结果 共纳入文献 8 篇，包
括临床决策 1 篇、指南 4 篇、专家共识 3 篇。1 篇临床决策来自 UpToDate 直接纳入；4 篇指南中 2 篇质量评价为 B 级，
2 篇为 A 级，均纳入；3 篇专家共识的质量评价结果均为准予纳入。最终围绕评估内容、处理方式、健康教育 3 个方
面共汇总 9 条最佳证据，其中 5 条证据为 A 级推荐，4 条为 B 级推荐。结论 本研究检索了糖尿病患者甲病管理相关
的临床决策、指南及专家共识，通过分析总结了糖尿病患者甲病管理的最佳证据，涉及评估内容、处理方式、健康教
育3个方面，证据等级为A级推荐和B级推荐，可为医务人员针对糖尿病患者进行甲病的早期评估与处理提供循证证据。
【关键词】 糖尿病足；糖尿病；甲病；指（趾）甲；循证医学；证据总结
【中图分类号】 R 587.29 【文献标识码】 A DOI：10.12114/j.issn.1007-9572.2022.0362
陈欢，侯朝铭，高静，等 . 糖尿病患者甲病管理的最佳证据总结［J］. 中国全科医学，2022，25（32）：3984-3990. ［www.
chinagp.net］
CHEN H，HOU C M，GAO J，et al. Evidence summary for management of nail diseases in patients with diabetes［J］.
Chinese General Practice，2022，25（32）：3984-3990.

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Evidence Summary for Management of Nail Diseases in Patients with Diabetes CHEN Huan，HOU Chaoming ，GAO
Jing，BAI Dingxi，WU Chenxi，WANG Hao，YOU Qian ，XIAN Yuanyuan
School of Nursing，Chengdu University of Traditional Chinese Medicine，Chengdu 611137，China
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Corresponding author：HOU Chaoming，Associate professor；Associate chief physician；E-mail：983729484@qq.com
【Abstract】 Background Timely identification and proper treatment of nail disease is of great significance to the
prevention of foot ulcer in diabetes. However，insufficient understanding of nail disease is highly prevalent in clinical workers.
What's more，there is a lack of a summary of the best evidence about clinical management of nail diseases in diabetes in China.
Objective To comprehensively retrieve and analyze evidence about the management of nail disease in diabetes，and give
a summary of the best evidence. Methods We searched databases of BMJ Best Practice，UpToDate，WHO，Guidelines
International Network，NICE，National Guideline Clearinghouse，RNAO，Scottish Intercollegiate Guidelines Network，New
Zealand Guidelines Group，Yimaitong，JBI，PubMed，Embase，CINAHL，CNKI and Wanfang Data for clinical decisions，
guidelines，systematic reviews and expert consensuses regarding the management of nail diseases in diabetes included as of
December 6，2021. Then we evaluated the quality of the evidence，and rated it according to the 2016 Supporting Document
for the Joanna Briggs Institute Levels of Evidence and Grades of Recommendation，and summarized the best evidence. Results
A total of 8 studies were enrolled，including 1 about clinical decisions，4 guidelines and 3 expert consensuses. The clinical
decisions was from the UpToDate and directly included. Two guidelines were rated B，and the other 2 were rated A，all of which
were allowed to be included. All the expert consensuses showed a high level of quality，and were allowed to be included. Finally，
9 items of best evidence regarding nail disease assessment，handling and health education were summarized，including 5 A-level
recommendations and 4 B-level recommendations. Conclusion This study searched the clinical decisions，guidelines and expert
consensus related to the management of patients with diabetes mellitus，and summarized the best evidence of the management of
基金项目：成都中医药大学“杏林学者”学科人才科研提升计划（MPRC2021021）
611137 四川省成都市，成都中医药大学护理学院
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通信作者：侯朝铭，副教授，副主任医师；E-mail：983729484@qq.com
本文数字出版日期：2022-08-25