本文针对二分类变量结局指标相对（而非绝对）治疗效果的不一致性。证据本身不会因不同研究结果具有一致性而升级，但可能因不一致而降低质量级别。衡量一致性的标准包括点估计值的相似性、可信区间的重叠程度以及统计学判定标准包括异质性检验和I2。系统评价作者应提出并检验少数几个与患者、干预措施、结局指标以及方法学相关的先验假设以探寻异质性来源。当不一致性很大且无法解释时，因不一致性而降低质量级别是恰当的，特别当某些研究显示有显著益处而其他显示无益甚至有害时（而非仅是疗效大与疗效小的比较）。明显的亚组效应可能不可靠。如果亚组效应满足以下条件，其可信度将会增加：基于少数几个有具体方向的先验假设、亚组比较来自研究内而非研究间、交互检验的P值小、结果有生物学意义。
Citation： Gordon H. Guyatt,Andrew D. Oxman,Regina Kunz,James Woodcock,Jan Brozek,Mark Helfand,Pablo AlonsoCoello,Paul Glasziou,Roman Jaeschke,Elie A. Akl,Susan Norris,Gunn Vist,Philipp Dahm,Vijay K. Shukla,Julian Higgins,Yngve FalckYtter,Holger J. Schnemann,代表GRADE小组. GRADE guidelines: 7. Rating the quality of evidence—inconsistency△. Chinese Journal of Evidence-Based Medicine, 2011, 11(12): 1444-1451. doi: 10.7507/1672-2531.20110244 Copy
Copyright © the editorial department of Chinese Journal of Evidence-Based Medicine of West China Medical Publisher. All rights reserved
-
Previous Article
GRADE guidelines: 6. Rating the quality of evidence—imprecision△ GordonGuyatt, Andrew D. Oxman, Regina Kunz, Jan Brozek, Pablo AlonsoCoello, David Rind, PJ Devereaux, Victor M. Montori, Bo Freyschuss, Gunn Vist, Roman Jaeschke, John W. Williams Jr., Mohammad Hassan Murad, David Sinclairk, Yngve FalckYtter, Joerg Meerpohl, Craig Whittington, Kristian Thorlund, Jeff Andrews, Holger J. Schnemann, 代表GRADE工作组 -
Next Article
GRADE guidelines: 8. Rating the quality of evidence—indirectness△ GordonGuyatt, Andrew D. Oxman, Regina Kunz, James Woodcock, Jan Brozek, Mark Helfand, Pablo AlonsoCoello, Yngve FalckYtter, Roman Jaeschke, Gunn Vist, Elie A. Akl, Piet N Post, Susan Norris, Joerg Meerpohl, Mona Nasser, 代表GRADE工作组
