国内护理领域系统评价/Meta分析的方法学与报告质量评价

目的评价国内护理领域系统评价/Meta分析方法学和报告质量,以期规范研究过程和报告方法。方法计算机检索CNKI,查找涉及护理领域的所有系统评价/Meta分析文献,检索时限从建库至2011年12月。由2位评价者独立筛查文献,并采用AMSTAR和PRISMA评价量表对纳入文献的方法学与报告质量进行评价并交叉核对,如遇分歧讨论解决。结果共纳入63篇文献,其中系统评价21篇,Meta分析42篇,分别发表在《护理研究》、《中华护理杂志》、《中国循证医学杂志》等13种期刊上。纳入文献中方法学质量存在的主要问题有:文献检索不够全面、对异质性产生的原因未进行综合分析和处理、未重视发表偏倚的识别。报告质量存在的主要问题表现在检索策略的报告不规范、纳入研究质量和偏倚风险报道不全面和研究结果表述不全(部分缺乏森林图、综合结果的估计值和可信区间、异质性检验结果)。结论目前国内护理领域系统评价/Meta分析的方法学质量及报告质量还存在不同程度的问题,尚需进一步提高方法学水平和规范报告质量。     

经皮冠状动脉介入术后应用国产和进口氯吡格雷安全性比较的系统评价

目的：系统评价国产氯吡格雷（泰嘉）与进口氯吡格雷（波立维）在接受冠状动脉介入术（PCI）患者中的安全性差异。方法采用Cochrane系统评价方法,计算机检索中国期刊全文数据库、中文科技期刊数据库、中国生物医学文献数据库等三大中文文献数据库,追踪检索已获得文献或相关研究提供的参考文献。对纳入文献进行质量评价和资料提取后,采用系统评价专用软件Review manager 4.2进行Meta分析。结果根据纳入标准和排除标准,最终有20个临床研究纳入Meta分析,包括4392例经皮冠状动脉介入患者,其中泰嘉组2066例,进口波立维组2326例。Meta分析主要结果显示,有11个研究报道了术后12个月的主要心血管不良事件（MACE）发生率,经异质性检验,I2=0%,表明研究结果间无统计学异质性,采用固定效应模型合并分析,泰嘉组和波立维组之间的MACE发生率无统计学差异（OR=1.00;95% CI：0.75～1.34;P=0.99）;有11个研究报道了术后12个月的不良反应发生率,经异质性检验,I2=0%,表明研究结果间无统计学异质性,采用固定效应模型合并分析,泰嘉组和波立维组之间的不良反应发生率无统计学差异（OR=1.14;95%CI：0.82～1.59;P=0.44）。结论经皮冠状动脉介入术后使用泰嘉和波立维的MACE和不良反应的发生等方面无明显差异,为泰嘉替代波立维抗血小板治疗提供了一定的循证医学证据。     

脑胶质瘤干预类系统评价/Meta分析的方法学和报告质量评价

目的系统评价全世界脑胶质瘤干预类系统评价/Meta分析（SR/MA）的方法学和报告质量。方法计算机检索Pub Med、EMbase、h e Cochrane Library、CNKI、CBM等数据库,纳入脑胶质瘤干预类SR/MA,检索时限截至2013年7月。由2位研究者独立筛选文献,而后采用AMSTAR和PRISMA清单对纳入研究的方法学与报告质量进行评价与分析。结果共纳入51个SR/MA。结果显示：纳入研究中方法学质量存在的主要问题有无研究设计方案、检索策略不全面、纳入研究出版物形式局限、未评价文章发表偏倚及未说明相关利益冲突;纳入研究的报告质量存在的主要问题是检索策略的报告不规范、纳入研究质量和偏倚风险报道不全面和研究结果表述不全（部分缺乏森林图、综合结果的估计值和可信区间、异质性检验结果）。结论脑胶质瘤干预类SR/MA的方法学质量和报告质量还存在不同程度的问题,该领域研究者应提高SR/MA制作的科学性和规范性,并遵循PRISMA进行报告。     

我国护理期刊系统评价/Meta分析的方法学质量评价

目的评价国内护理学领域发表的系统评价/Meta分析的方法学质量,为护理学领域相关研究提供指导。方法检索中国生物医学文献数据库、中国学术文献网络出版总库和中国科技期刊数据库,检索时间为各数据库建库到2013年8月,收集护理期刊上发表的系统评价及Meta分析,按照OQAQ量表中的10条评价项目对纳入文献逐一进行评价。结果共纳入74篇文献,其方法学质量评分为（2.92±1.63）分,分别有4.1%、8.1%、31.1%、43.2%、29.7%、55.4%、16.2%、37.8%、60.8%的研究充分报告了检索方法、检索足够全面、重复筛选、质量评价标准、数据支持其结论、提供了纳入排除清单、恰当地评价了文献、描述了数据合并方法、对结局数据进行了恰当的合并分析。结论护理学领域的系统评价/Meta分析的方法学质量整体较低,在检索策略、纳入排除标准、质量评价及数据分析方面表现尤其突出,研究者应进行严格的方法学培训。     

近5年中国科学引文数据库护理干预性系统评价/Meta分析报告质量分析

目的 评价近5年中国科学引文数据库收录的护理期刊发表的干预性系统评价/Meta分析的报告质量,以期规范其研究过程和报告方法,提升系统评价/Meta分析质量。方法 计算机检索CNKI、VIP、CBM和Wanfang数据库,搜集中国科学引文数据库收录的护理期刊发表的干预性系统评价/Meta分析研究,检索时限为2015年1月—2020年6月。由2名研究者独立筛选文献、提取资料,采用系统评价和Meta分析优先报告的条目进行报告质量评价;采用Office Excel 2019、Stata 15.0软件对相关数据进行统计和分析。结果 共纳入干预性系统评价/Meta分析176篇,其PRISMA评分为14.5~24.5分（20.17±2.00）,其中有1篇研究评分≤15分,有严重信息缺失;122篇评分为15~21分,存在一定报告缺陷;53篇评分为21~27分,报告相对完全。报告质量不足主要表现为结构式摘要（0/176）,方案和注册（0/176）,检索策略（55/176）,研究间偏倚（26/176）和资金支持（0/176）报告不全面。亚组分析结果显示：有基金资助、作者单位性质为医院和单位数为1个可明显提高系统评价/Meta分析报告质量（P<0.05）;作者人数对系统评价/Meta分析的报告质量影响不显著（P>0.05）。结论 目前,我国护理领域干预性系统评价/Meta分析的报告质量差异较大。因此,有必要采取相应的措施,加大对PRISMA的宣传和普及,推动其在护理期刊稿约中的引用;研究人员应严格遵守PRISMA相关条目,规范、详细地进行报告;护理期刊的编辑和审稿人在同行评审阶段也要严格遵循PRISMA的指导方针,以期提高系统评价/Meta分析的质量。     

文献质量评价工具在我国护理领域系统评价/Meta分析中的应用现况

目的：描述我国护理领域系统评价/Meta分析中文献质量评价工具的应用现状。方法计算机检索中国知网、中文科技期刊全文数据库、万方期刊论文数据库,全面收集护理领域发表的系统评价/Meta分析,提取文献质量评价的相关数据并进行分析。结果在纳入分析的441篇系统评价/Meta分析中,共提取出4大类18种文献质量评价工具。其中,189篇次（41.9%）应用Cochrane偏倚风险评估工具,119篇次（26.4%）使用Jadad量表,23篇次（5.1%）使用了JBI评价工具,17篇次（3.8%）使用 NOS量表。结论科学合理地应用文献质量评价工具有助于提高系统评价/Meta分析的证据质量,现阶段推荐使用Cochrane偏倚风险评估工具评价护理干预性研究的文献质量。     

总前列腺特异性抗原为4～10ng/mL时血清游离前列腺特异性抗原/总前列腺特异性抗原用于前列腺癌诊断的系统评价

目的系统评价总前列腺特异性抗原（t-PSA）为4～10ng/mL时血清游离前列腺特异性抗原/总前列腺特异性抗原（f/tPSA）用于前列腺癌诊断的临床价值。方法计算机检索中国生物医学文献数据库（1999～2009）、中文科技期刊全文数据库（1999～2009）、中国期刊全文数据库（1999～2009）和万方数据库（1999～2009）,并手工检索相关期刊,全面收集f/tPSA诊断前列腺癌的中文文献,按QUADAS条目对纳入研究进行质量评价。采用MetaDisc1.4软件检验各研究间的异质性,并按f/tPSA临界值0.1、0.15、0.2、0.25及0.3分组,进行Meta分析。结果最终纳入18个研究。异质性检验提示无阈值效应,但存在其他因素导致的异质性,按随机效应模型做Meta分析。结果显示f/tPSA临界值为0.15组的敏感度与特异度均较好,SROC曲线下面积及Q＊指数分别为0.8835和0.8140,明显高于其他组。结论 f/tPSA比值是前列腺癌诊断灰区（t-PSA为4～10ng/mL）的较好诊断指标,以0.15作为临界值较为适合。     

对射频消融术与肝切除术治疗小肝癌系统评价/Meta分析的方法学质量再评价

目的评价射频消融术(RFA)与肝切除术(HR)治疗早期肝癌的系统评价(SR)/Meta分析的方法学质量及其对结局的影响。方法系统检索PubMed等6个电子数据库和5个卫生技术评估(HTA)官方网站中的HTA、SR或Meta分析,检索时限均从建库至2012年11月11日。用OQAQ量表评价纳入研究的方法学质量;用Cochrane协作网的推荐工具和改良的MINORS量表分别评价随机对照试验(RCT)和非随机对照试验(NRCT)的方法学质量;用Stata 10.0软件整合Meta分析的OR值及其95%CI。结果共纳入1个HTA、3个SR和15个Meta分析,其OQAQ平均得分3.3分[95%CI(2.6,4.1)];仅5个研究(26.3%)可认为只有小缺陷,方法学质量评为Good。7个研究错用统计学模型,3个研究修正模型后改变原结局方向;5个研究(5/19)作者将回顾性对照研究作为RCT纳入。纳入的39个原始研究中,3个RCT质量为B级,35个NRCT质量中等,MINORS(总分18分)平均得分15.0分[95%CI(14.6,15.4)],仅13个(37.1%)得分≥16分。17个(43.6%)原始研究不符合纳入标准,其中9个(23.1%)混杂其他有效处理措施(TACE、PEI等),4个(10.3%)纳入非原发性肝癌患者。结论目前针对RFA和HR治疗小肝癌的HTA、SR和Meta分析的总体质量较差,异质性较高,证据水平较低。临床医生在使用这些证据指导临床决策时尚需谨慎。     

国内康复领域2018~2020年系统评价/Meta分析的报告质量评价

目的：评价国内康复领域2018～2020年发表的系统评价/Meta分析的报告质量。方法：检索中国知网和万方数据库,纳入《中国康复医学杂志》、《中华物理医学与康复杂志》、《中国康复理论与实践》、《中国康复》、《康复学报》自2018年1月～2020年12月期间发表的系统评价/Meta分析文章。分别采用PRISMA 2009清单、PRISMA-NMA量表和SWiM报告指南对Meta分析、网状Meta分析和定性系统评价的报告质量进行评价。结果：共纳入88篇文献（含85篇Meta分析、2篇网状Meta分析和1篇定性系统评价）。PRISMA清单结果显示Meta分析的报告质量平均为21.13±1.83分,其中报告相对规范（21.5～27分）的有41篇,报告有一定缺陷(15.5～21分)的有44 篇。报告缺陷主要集中在结构式摘要不完整、检索不规范、缺少研究方案和注册号以及未能进行合理的发表偏倚及其他分析。结论：国内康复领域已发表的系统评价/Meta分析的报告质量仍有待提高,建议研究者在撰写此类文章时应遵循相应的报告规范,促进我国循证康复的进一步发展。     

对系统评价/Meta分析报告规范的系统评价

目的全面收集系统评价/Meta分析的报告规范并对其进行评价,为系统评价/Meta分析的规范化发表及传播提供帮助。方法电子检索Ovid MEDLINE(1996～2010)及EMbase(截至2010年4月),纳入系统评价/Meta分析报告规范的文献,检索词包括guideline、report、systematic reviews、meta-analyses。通过阅读文题及摘要,排除无明显相关性的文献(针对具体疾病的系统评价,某一疾病的临床指南,以及仅讨论如何进行系统评价而未关注如何进行系统评价的报道等),而后进一步阅读全文,从纳入文献中提取如何报告系统评价/Meta分析的部分,并据其纳入原始研究设计的类型如随机对照试验、观察性研究、诊断性试验进行分类。结果初检获得285篇文献,最终纳入26篇文献。其中随机对照试验的系统评价/Meta分析报告规范有8篇,非随机对照试验(观察性研究)的系统评价/Meta分析报告规范2篇,诊断性试验的系统评价/Meta分析报告规范0篇,动物实验的系统评价/Meta分析报告规范1篇,针对系统评价/Meta分析的检索策略的报告规范2篇,评估系统评价/Meta分析质量的5篇,研究报告规范对系统评价/Meta分析质量影响的6篇。有2个指南更新。结论目前系统评价/Meta分析报告规范数量较多,其中QUOROM及其更新版本PRISMA被众多期刊广泛采纳。报告规范有利于提高系统评价和Meta分析的报告质量,尚需制定针对具体专业系统评价/Meta分析的报告规范。     

中药治疗心房颤动的系统评价再评价

目的对中药治疗心房颤动的系统评价进行再评价。方法计算机检索PubMed、The Cochrane Library、EMbase、CNKI、CBM、WanFang Data和VIP数据库,搜集中药治疗心房颤动的系统评价(SR),检索时限均为建库至2019年7月。由2名研究员独立筛选和提取资料后,应用AMSTAR2量表、PRISMA声明和GRADE方法对纳入研究的方法学质量、报告质量和证据质量进行评价。结果最终纳入20个SR,其中15个合并分析了临床疗效,12个对不良反应进行了分析。纳入SR的AMSTAR2方法学质量评价整体偏低,评价为高质量的0篇,低质量1篇,极低质量19篇;得分较差的条目为条目2、7、8、9、10、12、13、14、16。纳入SR的PRISMA得分在14~22.5分之间,报告质量问题主要表现在方案与注册、资料条目、其他分析方法和资金来源方面。采用GRADE进行结局指标证据体评价,证据体质量普遍较低。结论中药治疗房颤可提高临床疗效,减少不良反应,但所纳入文献整体方法学质量不高,证据体质量普遍偏低,建议进一步开展高质量临床研究,为评价中药治疗房颤临床疗效提供依据。     

Epidemiology,methodological and reporting characteristics of systematic reviews of nursing interventions published in China

The importance of systematic reviews (SRs) of nursing interventions' impact on practice makes their methodological quality and reporting characteristics especially important as it directly influence their utility for clinicians, patients and policy makers.The study aims to assess the methodological quality and reporting characteristics of SRs of nursing interventions in Chinese nursing journals. Three Chinese databases were searched for SRs of nursing interventions from inception to October 2011. The assessment of multiple systematic reviews (AMSTAR) and Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) statements were used to assess methodological quality and reporting characteristics. Seventy‐four SRs were included. The proportion of SRs complying with AMSTAR checklist items ranged from 0% to 82.4%. No SRs reported an ‘a priori’ design or conflict of interest. Only four items were found to be reported in more than 50% of the SRs: a list of included and excluded studies, the scientific quality of included studies, the appropriate use of methods to combine findings, and formulating conclusions appropriately. The majority of SRs of nursing interventions in China had major methodological and reporting flaws that limited their value to guide decisions. Chinese authors and journals should adopt and keep up with the AMSTAR and PRISMA statements to improve the quality of SRs in this field.     

Epidemiology, quality, and reporting characteristics of systematic reviews of acupuncture interventions published in chinese journals

Abstract Background: Systematic reviews (SRs) of acupuncture have become increasingly popular in China in recent years and have been published in large numbers. This review provides the first examination of epidemiological characteristics of these SRs as well as compliance with the PRISMA and AMSTAR guidelines. Objectives: The study objectives were to examine epidemiological and reporting characteristics as well as methodological quality of SRs of acupuncture published in Chinese journals. Methods: Four (4) Chinese databases were searched (CBM, CSJD, CJFD, and Wanfang Database) for SRs of Traditional Chinese Medicine, from January 1978 through to December 2010. Data were extracted into Excel spreadsheets. The PRISMA and AMSTAR checklists were used to assess reporting characteristics and methodological quality, respectively. Results: A total of 88 SRs were identified; none of the reviews had been updated. Less than one third (27.3%) were written by clinicians and one third (35.2%) were reported in specialty journals. The impact factor of 53.4% of the journals published was 0. Information retrieval was not comprehensive in more than half (59.1%) of the reviews. Less than half (36.4%) reported assessing for publication bias. Though 97.7% of the reviews used the term "systematic review" or "meta-analysis" in the title, no reviews reported a protocol and none were updated even after they had been published after 2 or more years. Conclusions: Although many SRs of acupuncture interventions have been published in Chinese journals, the reporting quality is troubling. Thus, the most urgent strategy is to focus on increasing the standard of SRs of acupuncture interventions, rather than continuing to publish them in great quantity.     

Ginger for health care: An overview of systematic reviews

ObjectivesTo summarize the evidence from systematic reviews (SRs) and meta-analyses that evaluated the efficacy of ginger in treating any conditions and critically assess the quality of these evidence.MethodsA systematic search of the literature was conducted from inception until February 28, 2019 using the PubMed, EMBASE, Web of science, Cochrane library, and four Chinese databases. Literature selection and data extraction were conducted by two independent reviewers. The quality of SRs was evaluated using the AMSTAR-2 tool. The GRADE system was used to assess the quality of evidence.ResultsTwenty-seven SRs were included. The number of included studies were various, range from 3 to 27. The condition with the most included SRs was nausea and vomiting (n = 12, 44.4%). Many SRs showed a promising efficacy of ginger, including nausea and vomiting, metabolic syndrome and pain, while the effect of ginger for platelet aggregation failed to draw a certain conclusion. The quality of SRs was heterogeneous. All of included SRs well complied with the Item 1 (“research questions included the components of PICO”) and Item 3 (“explained selection of the study designs for inclusion”). Twenty review failed to provide registration information. Only one SR reported the sources of funding for studies included.ConclusionsIn our overview, most of SRs suggest ginger is a promising herbal medicine for health care, which is beneficial for nausea and vomiting, metabolic syndrome and pain. However, considering the limited quality of included evidence and heterogeneity of different clinical trials, more well-design studies are required to confirm the conclusion further.     

Chinese medicine formulas for nonalcoholic fatty liver disease: Overview of systematic reviews

BACKGROUNDNonalcoholic fatty liver disease (NAFLD) affects more than one-quarter of the global population. Due to the lack of approved chemical agents, many patients seek treatment from traditional Chinese medicine (TCM) formulas. A variety of systematic reviews have been published regarding the effectiveness and safety of TCM formulas for NAFLD.AIMTo critically appraise available systematic reviews and sort out the high-quality evidence on TCM formulas for the management of NAFLD.METHODSSeven databases were systematically searched from their inception to 28 February 2020. The search terms included “non-alcoholic fatty liver disease,” “Chinese medicines,” “systematic review,” and their synonyms. Systematic reviews involving TCM formulas alone or in combination with conventional medications were included. The methodological quality and risk of bias of eligible systematic reviews were evaluated by using A Measure Tool to Assess Systematic Reviews 2 (AMSTAR 2) and Risk of Bias in Systematic Review (ROBIS). The quality of outcomes was assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.RESULTSSeven systematic reviews were ultimately included. All systematic reviews were conducted based on randomized controlled trials and published in the last decade. According to the AMSTAR 2 tool, one systematic review was judged as having a moderate confidence level, whereas the other studies were rated as having a low or extremely low level of confidence. The ROBIS tool showed that the included systematic reviews all had a high risk of bias due to insufficient consideration of identified concerns. According to the GRADE system, only two outcomes were determined as high quality; namely, TCM formulas with the HuoXueHuaYu principle were better than conventional medications in ultrasound improvement, and TCM formulas were superior to antioxidants in alanine aminotransferase normalization. Other outcomes were downgraded to lower levels, mainly because of heterogeneity among studies, not meeting optimal information sample size, and inclusion of excessive numbers of small sample studies. Nevertheless, the evidence quality of extracted outcomes should be further downgraded when applying to clinical practice due to indirectness.CONCLUSIONThe quality of available systematic reviews was not satisfactory. Researchers should avoid repeatedly conducting systematic reviews in this area and focus on designing rigorous randomized controlled trials to support TCM formula applications.     

中医药治疗绝经综合征的临床证据

目的总结国内外有关中医药治疗绝经综合征的系统评价/Meta分析证据,了解其疗效和安全性。方法以"更年期综合征、绝经综合征、围绝经期综合征"和"中医、中药、中医药"和"系统评价、Meta分析、循证医学"为检索词,检索Cochrane图书馆(2006年第4期)、MEDLINE(1991～2006)、OVID(1990～2006)、中国生物医学文献光盘(1990～2006)、中文科技期刊数据库(1989～2006)、中国学术期刊全文数据库(1979～2006)。查找有关中医药治疗绝经综合征的系统评价/Meta分析。结果外文数据库共检索到4篇,中文数据库共检索到2篇,均为中医药治疗绝经综合征的系统评价/Meta分析,对6篇文献进行归纳和总结。结论中医药治疗绝经综合征有一定的疗效,且安全性较高。但由于国外研究多为单味药研究,且研究数量偏少;国内研究的原始文献质量偏低等原因,降低了上述结论的可靠性,因此目前中医药对于绝经综合征的疗效及安全性的证据尚不够充分,尚需更严谨科学的试验以提供可靠性高的证据。     

The efficacy of acupuncture for attention deficit hyperactivity disorder (ADHD): An overview of systematic reviews and meta-analyses

BackgroundAttention deficit hyperactivity disorder (ADHD) is one of the most common neurological and mental developmental disorders in children. Published systematic reviews (SRs) and meta-analyses (MAs) concerning the use of acupuncture for ADHD have compared the efficacy of acupuncture treatment to that of drug therapies. However, the quality of these articles has not been evaluated and the evidence varies widely.ObjectiveTo summarize and assess the efficacy of acupuncture for ADHD based on existing SRs and MAs.MethodsA systematic search of the literature was conducted from inception until September 16 2021, using seven electronic databases. The AMSTAR-2 tool was used to evaluate the quality of SRs and MAs, and the GRADE system was used to assess the quality of evidence.ResultsThere are a total of five SRs and MAs included in this overview. Using the AMSTAR-2, three articles were rated as having ‘Low’ quality, while two were rated as having of ‘Critically Low’ quality. The GRADE system was used to measure the quality of evidence for ten outcomes (five response rate outcomes, three Conners’ Index of Hyperactivity (CIH) score outcomes, one Conners’ rating scale score outcome, and one Chinese medicine syndrome outcome) across the five included MAs. Four of the ten outcomes demonstrated ‘moderate’ quality, four demonstrated ‘low’ quality, and two demonstrated ‘very low’ quality. The risk of bias and inconsistency accounted for most downgrading factors in the included reviews.ConclusionIt is still debatable whether acupuncture is efficacious in improving the CIH score and the Response rate. Considering the heterogeneity of clinical trials and the fact that this study did not search and evaluate the relevant data of each randomized controlled trial, large-sample and high-quality randomized controlled trials are still needed to draw reliable conclusions regarding acupuncture's role in treating ADHD. Due to the poor quality of existing available evidence, little inference can be drawn from the included studies.     

Methodology and reporting quality of systematic review/meta-analysis of traditional Chinese medicine

CONTEXT: Good systematic reviews/meta-analyses are important sources of information for clinicians, patients, government officials, and other decision makers. Now, there is an increasing number of systematic reviews/meta-analysis of Traditional Chinese Medicine (TCM). Thus, it is necessary to assess the quality of these reviews. OBJECTIVE: To assess the methodology and reporting quality of systematic reviews/meta-analyses of TCM published in paper-based journals in China. METHODS: A comprehensive search of the literature was performed to identify the maximum possible number of reviews on the prevention and cure researches in TCM. Two assessors (Junhua and Hongcai) independently extracted data and put them into a Microsoft Access database for analysis. Two assessment tools were used: (1) the Oxman-Guyatt Overview Quality Assessment Questionnaire (OQAQ); and (2) the Quality of Reporting of Meta analysis (QUOROM). RESULTS: One hundred and seven papers (107) were identified: 71 reviews called "systematic reviews" and 36 called "meta-analyses." More than half of all the reviews had methodological and reporting flaws that could have influenced the reviews' validity. The deficiencies were mainly in literature searches, characteristics of included and excluded studies reported, primary trials' quality assessment, and data merging. CONCLUSIONS: The methodology and reporting quality are poor in both systematic reviews and meta-analysis reviews of TCM published in paper-based journals in China. We should respect the need for high-quality of systematic reviews and meta-analyses, and do these according to specification.     

中文期刊发表的中医药系统评价/Meta分析现状调查

目的调查国内中文期刊发表的中医药系统评价/Meta分析文献的质量。方法电子检索1995年1月到2006年12月的CNKI和CBM,筛选中医药的系统评价、Meta分析全文,提取有关中医特色、治疗和对照干预措施的详细资料进行分析评价,并调查文献是否采用QUOROM声明报道结果。结果共纳入文献111篇,其中预防、不良反应、危险因素及先兆症各1篇,理化指标2篇,疗效及安全性评价106篇。涉及42个病种,报道脑血管疾病的文献41篇。干预措施为中医药者25篇,针灸者12篇。对照组:未设对照者2篇;未描述对照组干预措施者15篇;阳性药物对照50篇(其中西药26篇,中药12篇,中药 西药12篇);空白对照14篇;基础对照17篇;假针灸、穴位注射等4篇;安慰剂对照5篇;空白对照14篇及“互为对照”4篇。对照组和部分研究治疗组的干预措施种类均多。每篇文献纳入RCT1～35篇不等,其中24个研究纳入CCT。111篇文献在Cochrane协作网注册者仅14篇。有16篇未对纳入RCT进行质量评价,有22篇仅对纳入RCT进行简单不规范的评价。无一篇文献采用QUOROM声明报道结果。结论应重视提高中医药系统评价的质量。根据中医药特点,选题范围不宜过宽,药物选择不宜过多,注意中药的目标适应病证,应重视对干预措施的评价。系统评价应注意由临床工作者和方法学研究者共同完成,才能做出质量高又具中医特色的评价。     

中医药治疗原发性高血压系统评价的再评价

目的评价中医药治疗原发性高血压系统评价的方法学偏倚及其结论的可靠程度。方法计算机检索PubMed、EMbase、The Cochrane Library(2014年第4期)、CBM、CNKI和WanFang Data数据库,查找中医药治疗原发性高血压的系统评价,检索时限均为从建库至2014年4月30日。采用AMSTAR工具评价纳入系统评价的方法学质量,并基于GRADE方法对系统评价纳入的结局指标进行证据质量分级。结果共纳入12个系统评价,包含31个结局指标,其中11个系统评价比较了中医药联合西药对比西药治疗原发性高血压的疗效,9个采用了Jadad量表作为系统评价纳入原始研究的方法学质量评估工具。AMSTAR工具评价结果显示,11个条目中,存在问题最多的是条目1"是否提供了前期设计方案"(12个未提供),其次是条目11"是否说明相关利益冲突"(9个未说明)和条目6"是否描述纳入研究的特征"(6个未描述)。GRADE分级结果显示:29个结局指标的证据质量均为低或极低,导致降级最主要因素为局限性(31个结局指标),其次为不精确(13个结局指标)和不一致(12个结局指标)。结论当前针对中医药治疗原发性高血压系统评价的方法学质量总体较差,结论的证据水平较低,对患者终点结局的关注程度不足。因此,临床医生在使用这些证据进行临床决策时尚需谨慎。