10 系统综述与meta分析.ppt

发表偏移 漏斗图 失安全系数 漏斗图 相对于样本量的效应值，是以研究的效应估计值作为横坐标，样本量作为纵坐标画出的散点图 漏斗图分析 1.根据图形的不对称程度判断Meta分析中偏倚有无 2.基于治疗效应的精确度随样本量增大而增加这一事实 漏斗图分析 图8-3 针灸治疗中风的49个试验的漏斗图分析 （Tang TL, 1999） 如果Meta分析中没有偏倚，图形构成一个对称的倒置“漏斗”；如果图形呈现明显的不对称，表明偏倚可能存在(见右图) 样本量小的研究结果通常分散在图形底部很宽的范围内 样本量大的研究结果集中在图形上部一个较窄的范围内 定义 Meta分析中计算需多少阴性研究结果的报告才 能使结论逆转 用途 估计发表偏移的程度 P为0.05和0.01时计算公式如下 * * 失效安全数 意义 失效安全数 ,说明Meta分析的结果越稳定,结论被 研究个数 各个独立研究的Ｚ值 推翻的可能性 方法的误用和滥用 为meta而meta 文献检索不全面 忽视制订研究方案及遵循正确的方法步骤 统计学处理 很多治疗还没有定量合并的方法 偏倚的识别和控制 观察性研究结果的Meta分析也开展了很多, 几乎占已发表Meta分析的一半, 主要是队列研究和病例对照研究在病因假设的检验或医学干预中的应用, 但由于观察性研究很难证明排除了一切偏倚, 也不可能完全去除混杂效应, 如果研究过程中确实存在相同的系统误差, Meta分析只会加大这些偏倚, 产生统计学上的假象, 因此观察性研究资料的Meta分析应慎重使用, 对Meta分析的结果亦应采取科学的态度进行解释, 重点应当放在检查研究结果异质性的可能来源上。 Thank You * * When there is variation in the effect size, which is if each study reports a difference in treatment effects, such as the percentage of reduction in the incidence of a condition. Often a study does not carry enough weight to make it statistically significant because of its sample size. If we able to combine the multiple, good quality, and similar small studies, this can increase the power and possibly provide a meaningful result. We should not use the results of one single study to provide us with a definitive conclusion on the effectiveness of an intervention, but rather pool the results of multiple similar studies to confirm the effectiveness. * * We have seen from the previous slide when meta-analysis can be useful, now we need to see in what situations it can be used. Studies to be included in meta-analysis should be similar to each other so that generalisation of results is valid. This is referred as homogeneity. This is calculated in MAStARI using Chi-square. The four main criteria that must be considered are: ??patient population (eg is it valid to combine the results of studies on different races of people, or different aged people?) ??outcome (eg is it valid to combine studies that have measured pain via