基于Meta回归算法评估烧伤临床营养系统评价的异质性  

Evaluation of the heterogeneity of systematic reviews on nutrition support for burn patients with Meta-regression algorithm

作　　者：蔡斌[1] 江华[1] 杨浩[1] 孙明伟[2] 王文渊[1] 曾俊[1] 

机构地区：[1]四川省医学科学院·四川省人民医院急诊医学与灾难医学研究所创伤代谢组多学科实验室计算数学与生物统计学教研组,成都610101 [2]四川省医学科学院创伤外科,成都610101

出　　处：《中华烧伤杂志》2013年第4期344-348,共5页Chinese Journal of Burns

基　　金：四川省科技厅基金（2011SZ0139）;四川省卫生厅基金（090422）

摘　　要：目的基于Meta回归算法对烧伤临床营养系统评价研究的异质性进行量化评估。方法检索《PubMed数据库》、荷兰《医学文摘》光盘数据库、《科学引文索引数据库》、《Cochrane中心随机对照试验（RCT）注册数据库》、《中国生物医学文献数据库》、《中文生物医学期刊数据库》和《中国期刊全文数据库》1980年以后的文献资料，鉴定烧伤临床营养系统评价研究。纳入标准包括：研究设计为干预性系统评价或Meta分析；烧伤患者年龄大于或等于18岁；采用临床营养类干预，制剂包括特殊营养素、途径包括肠内或肠外营养；结局指标为病死率。采用两步法分析系统评价的异质性，（1）定性分析：统计系统评价发表年份以及纳入临床研究外部设计、患者类型、营养素摄人（制剂或途径）、热量摄人、结局的报告情况；（2）定量分析：对系统评价纳入有结局报告的临床试验，建立其研究外部设计、发表时间、营养素摄入（制剂或途径）、热量摄入对病死率的Meta回归方程，采用广义线性回归模型以病死率作为回归结局变量得到各临床试验的预期死亡数，计算实际数／预期数（O／E）比及其95％置信区间鉴定系统评价中临床试验的异质性。结果（1）检索获得6项系统评价研究，时间跨度为10年，其中3项针对成人患者的系统评价报告了营养素摄人（制剂或途径）、热量摄人和结局3项特征指标中的2项。共纳人11项有患者结局报告的临床试验，包括10项RCT、l项病例对照试验。（2）Meta回归分析显示，与另外7项研究不同，4项RCT（5个研究组）存在显著异质性，不是来自于一个总体。对3项全面报告了营养素摄入（制剂或途径）、热量摄入及结局的RCT进行Meta回归分析，结果显示其无异质性。结论烧伤临床营养系统评价质量不高，所纳人的RCT有显著的异质性�Objective To evaluate the heterogeneity of systematic reviews （SRs） on nutrition sup- port for burn patients with Meta-regression algorithm quantitatively. Methods SRs on nutrition support for burn patients since 1980 were searched in 7 databases, including PubMed, EMBASE on CD, Science Citation Index, Cochrane Library, Chinese Biomedicine Database , Chinese Medical Current Contents , and Chinese Journal Full-text Database . SRs were identified with inclusion criteria： the research was inter- ventive SR or Meta analysis of clinical data of burn patients aged equal to or over 18 years who had received clinical nutrition intervention, with regimen including special nutrient given including enterally or parenteral- ly; the outcome indicator was mortality. A two-step method was established to evaluate the heterogeneity of SRs. （1） Qualitative analysis： the publication time of SRs and the trial design, patient type, regimen or route of nutrition therapy, energy intake, and outcome reported by the included clinical trial were analyzed. （2） Quantitative analysis： a mortality Meta-regression model was established by trial design, publication time, regimen or route of nutrition therapy, and energy intake to calculate the expected mortality. Observa- tion/expectation （O/E） ratio and its 95% confidence interval were calculated to identify the heterogeneity among the clinical trials of SRs. Results （ 1 ） Six SRs years. Only three SRs reported two of the three important were retrieved which were published within 10 parameters of nutrition intervention： regimen or route of nutrition therapy, energy intake, and clinical outcome. Totally, 11 clinical trials that gave outcome information were included in the SRs, including 10 RCTs and 1 case control trial. （2） Meta-regression anal- ysis showed that significant heterogeneity existed in 4 RCTs （ including five study groups） , which were dif- ferent from the other 7 trials. The patient samples of these 4 RCTs were from different population. No het

关 键 词：烧伤 循证医学 营养支持 异质性 Meta回归 系统评价 实际数 预期数比 

分 类 号：R644[医药卫生—外科学]