儿童1型糖尿病筛查的心理社会影响、可接受性与伦理：系统综述与混合方法证据合成
混合方法证据合成生成5个主题和19个亚主题，显示早期识别可引发焦虑但随时间消退，参与早期检测研究项目的父母重视知晓孩子风险且认为获益大于伤害，但儿科采血被认为具有挑战性。结论认为尽管存在情感、认知和行为影响，筛查对参与的父母/监护人似乎可接受，但关键证据缺口仍存。
要点
- 早期识别儿童1型糖尿病可引发焦虑，但焦虑随时间消退且可能复发。
- 参与早期检测研究项目的父母重视知晓孩子风险，认为获益大于伤害。
- 儿科采血被认为是筛查中的挑战，伦理聚焦于共同决策、结果披露权和数据完整性。
核心结论
- 尽管存在情感、认知和行为影响，迄今为止儿童1型糖尿病的筛查和早期检测对参与的父母/监护人似乎可接受，但关键证据缺口仍存。
研究设计与样本
- 系统综述检索MEDLINE、EMBASE、APA PsycInfo、ASSIA、CINAHL、Web of Science和Scopus，纳入截至2025年11月25日的定量、混合方法和定性文章。
- 使用混合方法评估工具和批判性评估技能清单进行质量评估，并进行混合方法证据合成。
主要发现
- 7篇文章（10.0%）满足所有质量标准（高质量），43篇（61.4%）满足60-80%标准（中等质量），20篇（28.6%）满足<50%标准（低质量）。
- 生成5个主题和19个亚主题。
- 早期识别1型糖尿病引发焦虑，随时间消退但可能复发。
- 参与早期检测研究项目的父母重视知晓孩子风险，认为获益大于伤害，但儿科采血被认为具有挑战性。
- 研究伦理围绕根据儿童年龄的共同决策、结果披露权和数据完整性的重要性。
关键数值与推荐
- 7篇文章（10.0%）满足所有质量标准（高质量）。
- 43篇文章（61.4%）满足60-80%标准（中等质量）。
- 20篇文章（28.6%）满足<50%标准（低质量）。
临床怎么用
- 临床沟通中应告知父母早期识别可能引发焦虑但多随时间消退，并重视父母对知晓风险的认可。
- 儿科采血需优化以减少挑战，伦理实践应注重按儿童年龄共同决策、结果披露权和数据完整性。
局限性
- 合成的研究池异质性大，反映对早期疾病理解演变，但可能影响筛查的可接受性。
- 关键证据缺口仍存。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
AIMS/HYPOTHESIS: Paediatric population screening for type 1 diabetes is emerging internationally. It is critically important to understand the acceptability of screening to inform these initiatives. In this systematic review, we aimed to assess the psychosocial impact, acceptability and ethics of screening for paediatric type 1 diabetes. METHODS: We searched MEDLINE, EMBASE, APA PsycInfo, ASSIA, CINAHL, Web of Science, Scopus, and included quantitative, mixed methods and qualitative articles until 25 November 2025. We assessed the emotional, cognitive and behavioural implications, acceptability or ethics of type 1 diabetes early detection for parents and/or children. We used the mixed methods appraisal tool and critical appraisal skills checklists for quality assessment. We performed a mixed methods evidence synthesis, identifying key themes from qualitative data and merging with quantitative data to generate meta-inferences. RESULTS: Seventy articles (12 qualitative, 57 quantitative and one mixed methods) involving 62,244 parents and 6363 children aged <18 years were included. Seven articles (10.0%) met all quality criteria (high quality), 43 (61.4%) met 60-80% of criteria (moderate quality) and 20 (28.6%) met <50% of criteria (low quality). We generated five themes and 19 sub-themes. Identification of early-stage type 1 diabetes generated anxiety, which waned over time but could recur. Overall, parents who opted into an early detection research programme valued knowing their child's risk and perceived benefits to outweigh harms, although paediatric blood sampling was considered challenging. Research ethics of screening centred on joint decision making according to the child's age, right to results disclosure and importance of data integrity. We synthesised a large pool of heterogenous studies, reflecting how understanding of early disease has evolved, but likely influencing the acceptability of screening. CONCLUSIONS/INTERPRETATION: This, the most comprehensive review of the literature to date, demonstrates that despite the emotional, cognitive and behavioural implications, thus far, screening and early detection of paediatric type 1 diabetes appears to be acceptable to parents/guardians who take part but critical evidence gaps remain. TRIAL REGISTRATION: PROSPERO registration no. CRD42024566937 FUNDING: EDENT1FI (grant no. 101132379).
引用
- Quinn LM, Stanley D, Milano F, et al. Psychosocial implications, acceptability and ethics of screening for paediatric type 1 diabetes: a systematic review and mixed methods evidence synthesis. Diabetologia. 2026. PMID: 42065735. doi:10.1007/s00125-026-06717-2
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。