北京大学Meta分析讲座.ppt

Meta－分析的统计学基础;一、 概 述;什么是循证医学 Evidence-based medicine (EBM) 循证医学是在对个体病人制定临床决策时应基于当前最佳的科学研究成果。 循证医学是最佳的证据、临床经验和病人价值的有机结合。;用X线进行乳腺癌筛查Mammography for breast cancer is an established screening method;The authors found that no trial data were of high quality Two were of medium quality, and the rest were poor quality or flawed. When the results of the two medium quality trials were combined, the risk ratio was 1.00 (95% CI 0.96, 1.05) They concluded that “screening for breast cancer with mammography is unjustified” ;The USPSTF recommends screening mammography, with or without clinical breast examination, every 1-2 years for women aged 40 and older. ;被动吸烟的危害;Hackshaw et al. conducted a very comprehensive systematic review in 1997 ;;什么是循证医学;循证方法的两个关键方面;循证医学证据的分级 ;系统性综述;循证医学与传统医疗实践的四个重要区别(1992 JAMA);Meta - analysis ;Systematic reviews/meta-analyses indexed in PubMed – 10 years;How to read a systematic review?;Evaluation of quality of primary studies sets systematic reviews apart from traditional reviews Empiric research shows that not all SRs assess study quality: 240 SRs from journals: 48% assessed quality (Moher 1999) 480 SRs in DARE: 52% assessed quality (Petticrew 1999) 50 SRs on asthma: 28% reported validity assessment criteria (Jadad 2000);Berkeley, 2002 on quality of SRs on HIV, published during 2001 Quality assessment done in 56% of reviews Testing for heterogeneity done in 56% of reviews Not all SRs with significant heterogeneity explored reasons for it Many reviews did not state the rationale for choice of models used for combining data Only 12% of reviews evaluated publication bias;近年Meta分析文献中存在的 主要问题 （2002年到2004年5月）;Meta分析流程图;异质性检验执行情况;发表偏倚的说明及评估; 因此当你找到所需的系统性综述时，你有责任去评价它的质量。;系统性综述与Meta-analyses的质量评价标准;二、 Meta analysis原理和基本思想 ;在用样本信息推断总体参数时，是存在抽样误差的，并且抽样误差的大小与样本量的大小有关。 统计学用抽样分布的理论来描述样??统计量的变化规律。; 从一个均数为1.5，标准差为0.7的正态总体中进行随机抽样，样本量分别为20，50，100，200，300，500，1000，不同的样本量均进行20次抽样，共得到140个样本。 分别计算每个样本的均数，标准差和标准误。 以样本的均数