循证医学-系统评价和meta分析-黄鹏（研）

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1、系统评价和Meta分析SystematicReviewandMeta-analysis南昌大学公共卫生学院黄鹏问题的提出对上述结果，是不是难以判断并选择？用X线进行乳腺癌筛查MammographyforbreastcancerisanestablishedscreeningmethodIsscreeningwithmammographyjustifiable?Gotzsche&Olsen[NordicCochraneCentre]conductedasystematicreviewin2000andupdateditin2001.Theyidentified8largeRCTsonthis

2、topic,withover182,000womenrandomizedTheauthorsfoundthatnotrialdatawereofhighqualityTwowereofmediumquality,andtherestwerepoorqualityorflawed.Whentheresultsofthetwomediumqualitytrialswerecombined,theriskratiowas1.00(95%CI0.96,1.05)Theyconcludedthat“screeningforbreastcancerwithmammographyisunjustifie

3、d”TheUSPreventiveServicesTaskForcereviewedthesamesetoftrialsRecently,a2001CochraneCollaborationreviewofthesametrialsconcludedthatsixoftheeighttrialswere"flawed"orof"poorquality"andthatthepooledresultsfromtheremainingtwobettertrialsdidnotsupportabenefitfrommammography.Themeta-analysisperformedforth

4、eUSPSTFonthemostcurrentpublisheddatafoundthatthepooledeffectsizeofthecombinedtrialswassizableandstatisticallysignificant:thesummaryrelativerisk(RR)ofbreastcancerdeathamongwomenrandomizedtoscreeninginseventrialsthatincludedwomenolderthan50was0.77(95percentCI,0.67-0.89).TheUSPSTFrecommendsscreeningm

5、ammography,withorwithoutclinicalbreastexamination,every1-2yearsforwomenaged40andolder.被动吸烟的危害AtopicofgreatdebateandcontroversyformanyyearsFirstfewepidemiologicstudieswerepublishedin1918Hackshawetal.conductedaverycomprehensivesystematicreviewin1997Theyidentified37publishedstudiesthatreportedrisko

6、flungcanceramonglifelongnon-smokingwomenaccordingtothehusband’ssmokingstatusTheirmeta-analysisrevealedthattheoverallriskoflungcanceramonglifelongnon-smokingwomenwas1.24timeshigherwhentheirhusbandssmoked,ascomparedtothosewomenwhosehusbandsdidnotsmoke.让我们来看看系统评价的真实面目系统评价的定义系统评价是一全新的文献综合评价临床研究方法，其基本过

7、程是以某一具体临床问题为基础，系统、全面地收集全世界所有已发表或未发表的临床研究结果，采用临床流行病学严格评价文献的原则和方法，筛选出符合质量标准的文献，进行定性或定量合成，去粗取精，去伪存真，得出综合可靠的结论。同时，随着新的临床研究结果的出现进行及时的更新。Systematicreview(SR)Systematicreview(SR)“Asummaryofthemedicalliteraturethatusesex