网状Meta分析在中医药领域的发表质量现状与应用价值Critical quality evaluation and application value of network Meta-analyses in traditional Chinese medicine
陈瑶;曾雪扬;刘涤非;谭小玉;蔡先明;杨丰文;廖星;孙凤;谢雁鸣;
CHEN Yao;ZENG Xue-yang;LIU Di-fei;TAN Xiao-yu;CAI Xian-ming;YANG Feng-wen;LIAO Xing;SUN Feng;XIE Yan-ming;Institute of Public Health,Peking University;Center for Evidence Based Medical and Clinical Research,Peking University;Centre for Evidence-Based Medicine,Tianjin University of Traditional Chinese Medicine;Institute of Basic Research in Clinical Medicine,China Academy of Chinese Medical Sciences;
摘要(Abstract):
该研究通过全面梳理中医药领域已发表的网状Meta分析(NMA)的系统综述,介绍NMA在中医药领域的应用现状,并探讨NMA在中医药领域的应用价值。系统检索中国知网(CNKI)、万方数据库、Sino Med、维普网、Embase、PubMed和Cochrane Library,并手动检索既往文献参考文献列表,全面收集中医药主题下的NMA文献,提取文献的基本信息和研究设计信息。使用AMSTAR量表对文献方法学质量进行评估,使用PRISMA-NMA核查清单衡量报告规范程度。最终,共纳入122篇文献,其中中文80篇,英文42篇。结果显示目前中医药领域已发表的网状Meta分析主要涉及癌症、骨关节疾病、心血管疾病、呼吸系统疾病、精神类疾病和消化系统疾病这六类疾病;比较的干预措施大致分为三类,中药注射剂、中成药或方剂和针灸等物理疗法;有近1/3的研究干预方案为中西医结合治疗。整体方法学质量等级为中等,亚组分析结果显示英文文献方法学质量显著高于中文文献,2015年后发表的文献质量高于2015年及之前发表的文献。整体报告质量一般,尤其在方法和结果报告方面有待提高。NMA突破了传统Meta分析仅能对2个干预措施比较的限制,与中医药复杂的"同病异治"特点更加契合。结果提示目前中医药领域的NMA应用尚处于发展阶段,整体方法学质量中等,在方法和结果部分的报告规范程度有待提高。
To introduce the application status of network Meta-analysis( NMA) in the field of traditional Chinese medicine,and to discuss the application value of NMA in the field of traditional Chinese medicine,this study comprehensively reviewed the systematic reviews with application of NMA in the field of traditional Chinese medicine. CNKI,Wan Fang,Sino Med,VIP,Embase,PubMed and Cochrane Library and the reference list of previous studies were searched. The AMSTAR scale was used to evaluate the quality of literature methodology,and PRISMA-NMA checklist was used to measure the degree of report specification. Overall,122 articles were included,including 80 in Chinese and 42 in English. The included studies centered on cancer,bone and joint disease,cardiovascular disease,respiratory disease,mental disease and digestive disease. Additionally,the intervention can be categorized into three groups,traditional Chinese medicine injection,oral Chinese medicine or prescription,and traditional physical therapy including acupuncture.Nearly one-third of the researches' intervention program is aimed at comparing the effect of Chinese and Western combined therapy and monotherapy. The overall methodology quality grade is medium and the report quality is average,with methodology reporting and result reporting especially need to be improved. The subgroup analysis shows that the methodology quality of the English literatures is evidently higher than Chinese literatures,and the quality of the literatures published after 2015 is higher than those published in or before 2015.This study indicates that the NMA can compare multiple treatments simultaneously,which accords with characteristics of the clinical practice in traditional Chinese medicine that is complex and individual. NMA in the field of traditional Chinese medicine is still in the process of development. With higher level of quality control and reporting as well as the improvement of the statistical methodology and the accumulation of original researches,NMA application in the field of traditional Chinese medicine will be promising.
关键词(KeyWords):
中医药;网状Meta分析;现状分析;质量评价;报告规范;应用价值
traditional Chinese medicine;network Meta-analysis;descriptive analysis;quality assessment;reporting checklist;application value
基金项目(Foundation): 国家自然科学基金项目(71673003,81774159);; 2019北京大学“教学新思路”项目(2019YX007);; 中国中医科学院基本科研业务费专项(ZZ13-YQ-075,Z0650)
作者(Author):
陈瑶;曾雪扬;刘涤非;谭小玉;蔡先明;杨丰文;廖星;孙凤;谢雁鸣;
CHEN Yao;ZENG Xue-yang;LIU Di-fei;TAN Xiao-yu;CAI Xian-ming;YANG Feng-wen;LIAO Xing;SUN Feng;XIE Yan-ming;Institute of Public Health,Peking University;Center for Evidence Based Medical and Clinical Research,Peking University;Centre for Evidence-Based Medicine,Tianjin University of Traditional Chinese Medicine;Institute of Basic Research in Clinical Medicine,China Academy of Chinese Medical Sciences;
Email:
DOI: 10.19540/j.cnki.cjcmm.20191022.501
参考文献(References):
- [1]李慧,宋晓亭.中药品种保护制度的价值解读[J].中草药,2018,49(18):4468.
- [2]崔璨.中药品种保护制度研究[D].南京:南京中医药大学,2017.
- [3]刘艳,吁海超,章军,等.以质量为核心的优质中成药评价标准研究[J].中国中药杂志,2018,43(21):4356.
- [4]秦昆明,曹岗,金俊杰,等.中药饮片炮制工艺现代研究中存在的问题与对策[J].中国中药杂志,2018,43(18):3795.
- [5] Pandis N. The evidence pyramid and introduction to randomized controlled trials[J]. Am J Orthod Dentofacial Orthop,2011,140(3):446.
- [6] Jansen J P,Fleurence R,Devine B,et al. Interpreting indirect treatment comparisons and network Meta-analysis for health-care decision making:report of the ISPOR task force on indirect treatment comparisons good research practices:part 1[J]. Value Health,2011,14(4):417.
- [7] Lumley T. Network Meta-analysis for indirect treatment comparisons[J]. Stat Med,2002,21(16):2313.
- [8] Bucher H C,Guyatt G H,Griffith L E,et al. The results of direct and indirect treatment comparisons in Meta-analysis of randomized controlled trials[J]. J Clin Epidemiol,1997,50(6):683.
- [9] Song F,Altman D G,Glenny A M,et al. Validity of indirect comparison for estimating efficacy of competing interventions:empirical evidence from published Meta-analyses[J]. BMJ,2003,326(7387):472.
- [10] Salanti G,Higgins J P,Ades A E,et al. Evaluation of networks of randomized trials[J]. Stat Methods Med Res,2008,17(3):279.
- [11] Lu G,Ades A E. Combination of direct and indirect evidence in mixed treatment comparisons[J]. Stat Med,2004,23(20):3105.
- [12] Caldwell D M,Ades A E,Higgins J P. Simultaneous comparison of multiple treatments:combining direct and indirect evidence[J]. BMJ,2005,331(7521):897.
- [13]杨丰文,张俊华,张伯礼.中医药网状Meta分析质量评价[J].中华中医药杂志,2018,33(10):4599.
- [14] Shea B J,Grimshaw J M,Wells G A,et al. Development of AMSTAR:a measurement tool to assess the methodological quality of systematic reviews[J]. BMC Med Res Methodol,2007,7:10.
- [15] Hutton B,Salanti G,Caldwell D M,et al. The PRISMA extension statement for reporting of systematic reviews incorporating network Meta-analyses of health care interventions:checklist and explanations[J]. Ann Intern Med,2015,162(11):777.
- [16]李志霞,杨俊,叶欣,等.系统综述与网状Meta分析的PRISMA扩展声明[J].中国循证心血管医学杂志,2016,8(6):656.
- [17]田金徽.中药注射剂联合化疗治疗非小细胞肺癌的网状Meta分析[D].兰州:兰州大学,2012.
- [18]田金徽,赵晔,李金龙,等.12种中药注射剂联合吉西他滨和顺铂化疗方案治疗非小细胞肺癌的网状Meta分析[J].中国药物评价,2014,31(6):350.
- [19]田金徽,赵晔,李金龙,等.10种中药注射剂联合长春瑞滨+顺铂化疗方案治疗非小细胞肺癌的网状Meta分析[J].中国药物评价,2015,32(1):45.
- [20]赵晔,刘丹璐,李金龙,等.9种中药注射剂联合多西他赛和顺铂/卡铂治疗非小细胞肺癌的网状Meta分析[J].中国药物评价,2014,31(5):295.
- [21]刘志强,陈春林,王博龙.中药注射液联合吉非替尼治疗非小细胞肺癌的网状Meta分析[J].中成药,2018,40(4):994.
- [22]刘园园.吉非替尼、厄洛替尼和埃克替尼治疗非小细胞肺癌临床疗效及不良反应的网络Meta分析[D].石河子:石河子大学,2017.
- [23]马丹丽,习元堂,蒋凯林,等.滋肾育胎丸联合孕激素治疗先兆流产的Meta分析和间接比较[J].广州中医药大学学报,2018,35(4):751.
- [24]李红.中医药在国外发展的特点和启示[J].中华中医药杂志,2006(6):359.
- [25]胡佳卉.基于信息处理的中医药治疗2型糖尿病方药数据挖掘与分析研究[D].北京:北京中医药大学,2017.
- [26]郑蕊,陈静,樊官伟,等.潜在恶性心律失常治疗进展及中医药防治特点与前景[J].中医杂志,2015,56(18):1615.
- [27]张伯礼.辨证论治与循证医学[J].中国循证医学,2002(1):1.
- [28]赵鑫,王阶,陈光.中医临床路径发展现状及对策研究[J].中国医院管理,2019,39(2):44.
- [29]刘旭东.类风湿关节炎实验室指标与中医证型的相关性研究[D].郑州:河南中医学院,2015.
- [30]季涛,宿树兰,尚尔鑫,等.基于关联规则的中医药治疗消渴症的用药规律与特点探析[J].中华中医药杂志,2016,31(12):4982.
- [31]张泽.中医与循证医学:从理论到实践[J].中华中医药杂志,2015,30(10):3417.
- [32]吴弘文,陈岭,经蕾,等.基础心率慢而早搏频发的西医治疗现状及中医药治疗特点[J].中国中医基础医学杂志,2018,24(3):347.
- [33]梁献葵,王艳慧,雷敬卫,等.不同产地加工炮制方法对栀子质量的影响[J].中国中药杂志,2018,43(16):3285.
- [34]王凤云,唐旭东,刘果,等.胃食管反流病食管外症状表现特点及中医药治疗[J].中国中西医结合杂志,2011,31(5):716.
- [35]华贵新.中医肿瘤治疗方法学探讨[J].中医临床研究,2016,8(4):49.
- [36] Sonya J,Snedecor D A. From pairwise to network Meta-analyses[M]//Biondi-zoccai G. Network Meta-analyses evidence synthesis with mixed treatment comparison. New York:Nova Science Publishers,2014.
- [37]李楠,雷翔,曹红波,等.网状Meta分析及其在中医药领域的应用[J].中医杂志,2015,56(15):1286.
- [38]杨丰文,田金徽,张俊华,等.中医药网状Meta分析方法及要点[J].中医杂志,2017,58(10):841.
- [39]杨丰文,张明妍,李越,等.中医药网状Meta分析应用策略探讨[J].中华中医药杂志,2017,32(5):2250.
- 中医药
- 网状Meta分析
- 现状分析
- 质量评价
- 报告规范
- 应用价值
traditional Chinese medicine - network Meta-analysis
- descriptive analysis
- quality assessment
- reporting checklist
- application value
- 陈瑶
- 曾雪扬
- 刘涤非
- 谭小玉
- 蔡先明
- 杨丰文
- 廖星
- 孙凤
- 谢雁鸣
CHEN Yao- ZENG Xue-yang
- LIU Di-fei
- TAN Xiao-yu
- CAI Xian-ming
- YANG Feng-wen
- LIAO Xing
- SUN Feng
- XIE Yan-ming
- Institute of Public Health
- Peking University
- Center for Evidence Based Medical and Clinical Research
- Peking University
- Centre for Evidence-Based Medicine
- Tianjin University of Traditional Chinese Medicine
- Institute of Basic Research in Clinical Medicine
- China Academy of Chinese Medical Sciences
- 陈瑶
- 曾雪扬
- 刘涤非
- 谭小玉
- 蔡先明
- 杨丰文
- 廖星
- 孙凤
- 谢雁鸣
CHEN Yao- ZENG Xue-yang
- LIU Di-fei
- TAN Xiao-yu
- CAI Xian-ming
- YANG Feng-wen
- LIAO Xing
- SUN Feng
- XIE Yan-ming
- Institute of Public Health
- Peking University
- Center for Evidence Based Medical and Clinical Research
- Peking University
- Centre for Evidence-Based Medicine
- Tianjin University of Traditional Chinese Medicine
- Institute of Basic Research in Clinical Medicine
- China Academy of Chinese Medical Sciences