在元分析中,分析策略与治疗结果估计之间的关联
Agnes Dechartres1, Douglas G Altman2, Ludovic Trinquart3
1Centre de Recherche Epidémiologie et Statistique, INSERM U1153, Paris, France2Centre d'Épidémiologie Clinique, Hôpital Hôtel Dieu, Assistance Publique des Hôpitaux de Paris, Paris, France3Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cit.
JAMA
|August 14, 2014
概括
在元分析中包括所有试验,特别是主观结果,往往会产生更大的治疗效果. 这凸显了元分析中敏感性分析的重要性,以确保可靠的结论.
科学领域:
- 生物统计学 生物统计学
- 临床流行病学临床流行病学
- 证据综合 证据综合
背景情况:
- 分析对于合成研究结果至关重要.
- 一个关键的挑战是决定是否包括所有可用的试验或使用选择性策略.
研究的目的:
- 将包括所有试验在内的元分析中的治疗结果与替代策略进行比较.
- 调查不同纳入标准对元分析结果的影响.
主要方法:
- 分析了来自高影响期刊和科克兰数据库的163个元分析 (1,240个随机临床试验).
- 对比所有试验的元分析与策略,如单一最精确的试验,最大的试验,限制元分析,和偏差低风险的试验.
- 使用概率比率 (ROR) 来量化差异,其中ROR> 1表示包含所有试验的更大结果.
主要成果:
- 对所有试验的元分析显示,与单一最精确的试验相比,主观 (ROR 1.13) 和客观 (ROR 1.03) 结果的治疗结果都更大.
- 在51%的主观和39%客观结果元分析中观察到实质性的差异.
- 当将所有试验纳入与其他策略进行比较时,发现了不同的结果,强调结果的不稳定性.
结论:
- 在元分析中,治疗结果的估计根据所采用的分析策略有很大差异.
- 这种变化可能导致结论发生重大转变,这强调了系统敏感性分析的必要性.
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