华西医学

华西医学

皮质类固醇激素辅助治疗重症肺炎的系统评价/meta 分析方法学与报告质量评价

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目的 对皮质类固醇激素辅助治疗重症肺炎疗效及安全性的系统评价/meta 分析进行方法学与报告质量评价。 方法 计算机检索 PubMed、Embase、Cochrane Library、中国知网、万方和维普数据库,检索皮质类固醇激素作为辅助手段治疗重症肺炎的系统评价/meta 分析,检索时间为建库至 2018 年 10 月 25 日。经 2 位评价员独立筛选文献、提取资料后,用系统评价的质量评价工具-2(A Measurement Tool to Assess Systematic Review-2,AMSTAR-2)评价纳入研究的方法学质量,用系统评价和 meta 分析优先报告的条目(Preferred Reporting Items for Systematic Reviews and Meta-Analyses,PRISMA)声明评价文献报告质量。 结果 共纳入 16 个系统评价/meta 分析,均为非 Cochrane 系统评价。AMSTAR-2 评价方法学质量方面,所有文献均无计划书;仅 1 篇文献说明了纳入研究类型的原因;8 篇文献未详细描述干预/对照措施的剂量、随访时间;3 篇文献未注明评价工具,且未对风险偏倚进行评价描述;6 篇文献未明确检验发表偏倚。PRISMA 评价报告质量方面,所有研究均无预先注册的研究方案以及注册号,13 篇文献未描述各个库检索的具体文献量,3 篇文献未详细展现其检索策略及排除原因,所有文献均未注明纳入研究的资金来源,仅 8 篇文献既报告了本研究有无资金资助又申明了其是否存在利益冲突。 结论 目前皮质类固醇激素辅助治疗重症肺炎疗效及安全性的系统评价/meta 分析研究较多,整体研究质量逐渐提高,但研究的共性问题比较突出,重症肺炎研究的干预时长、干预剂量各异,基线难以统一。建议加强对研究人员培训,规范研究流程,严格按照 PRISMA 声明进行文章报告;根据激素的剂量及应用时长进行亚组分析研究。

Objective To evaluate the methodological and reporting quality of systematic reviews/meta-analyses related to the efficacy and safety of corticosteroid-assisted treatment for severe pneumonia. Methods PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, WanFang Data and VIP databases were searched by computer, and the systematic reviews/meta-analyses of corticosteroid hormone as an auxiliary means for the treatment of severe pneumonia which were published from establishment of the databases to October 25th, 2018 were searched. A Measurement Tool to Assess Systematic Review-2 (AMSTAR-2) was used to assess the methodological quality of the included studies, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to evaluate the quality of literature reports. Results A total of 16 systematic reviews/meta-analyses were included, all of which were non-Cochrane systematic reviews. In terms of methodological quality assessed by AMSTAR-2, there was no plan in all studies; only one study explained the reasons for inclusion in the study type; eight studies did not describe the dose and follow-up time of the intervention/control measures in detail; three studies did not indicate the evaluation tools and did not describe the risk bias; six studies did not explicitly examine publication bias. In terms of reporting quality assessed by PRISMA, all studies had no pre-registered study protocol or registration number; thirteen studies did not describe the specific amount of articles retrieved from each database; three studies did not present their retrieval strategies or excluded reasons in detail; no funding sources were identified in included studies; eight studies reported both whether the study was funded and whether there was a conflict of interest. Conclusions At present, there are many systematic review/meta-analysis studies on the efficacy and safety of corticosteroid-assisted treatment for severe pneumonia, and the overall quality of the study has been gradually improved. However, the common problems in the study are relatively prominent. The follow-up period and dose of intervention in the study of severe pneumonia are different, so the baseline is difficult to be unified. Suggestions: strengthening the training of researchers, standardize the research process, and report articles in strict accordance with the PRISMA statement; subgroup analysis being conducted according to the dose and duration of the hormone.

关键词: 皮质激素; 重症肺炎; 系统评价; Meta 分析; 报告质量; 方法学质量评价

Key words: Corticosteroids; Severe pneumonia; Systematic review; Meta-analysis; Reporting quality; Methodological quality assessment

引用本文: 郭茹, 刘利霞, 廖晓阳. 皮质类固醇激素辅助治疗重症肺炎的系统评价/meta 分析方法学与报告质量评价. 华西医学, 2019, 34(1): 74-81. doi: 10.7507/1002-0179.201901055 复制

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