關(guān)于如何寫好系統(tǒng)綜述2寫綜述？寫綜述？第2頁,共31頁，2024年2月25日，星期天3

綜述的類型和特點(diǎn)

綜述包括普通綜述、系統(tǒng)綜述和Meta分析：傳統(tǒng)綜述是常見的綜述形式，為某一主題的文獻(xiàn)結(jié)果的總結(jié)，但有逐漸被系統(tǒng)綜述取代的可能性。系統(tǒng)綜述是根據(jù)一定的入選標(biāo)準(zhǔn),系統(tǒng)地整理所有相關(guān)的觀察或?qū)嶒?yàn)研究的證據(jù),以回答一個特定的研究問題。特點(diǎn)為（1）目標(biāo)明確，方法學(xué)清晰且可復(fù)制；（2）進(jìn)行了系統(tǒng)化的文獻(xiàn)檢索，包括符合入選標(biāo)準(zhǔn)的所有文獻(xiàn)；（3）對文獻(xiàn)可靠性進(jìn)行了評價(jià)；（4）綜合包括的文獻(xiàn)的特征和研究結(jié)果并給予系統(tǒng)的陳述。Meta分析采用統(tǒng)計(jì)學(xué)的方法整合和總結(jié)所研究的文獻(xiàn)的結(jié)果。系統(tǒng)綜述可以包括Meta分析，也可以不包括。Meta分析與一般的系統(tǒng)綜述相比，可以對干預(yù)效果進(jìn)行更加準(zhǔn)確的估計(jì)。

(CochraneCollaboration的定義)第3頁,共31頁，2024年2月25日，星期天4AbstractC-reactiveprotein(CRP)isamarkerofsystemicinflammation,andithasbeenimplicatedinthepathogenesisofmanychronicdiseases,includingcardiovascular(CV)diseases.WithhighlysensitiveCRPassays,serumCRPcanaddconsiderablytostandardcoronaryheartdiseaseriskfactorsandinthepredictionofsubsequentmajorCVrisk.WereviewevidencesupportingtheassessmentofhighlysensitiveCRPbothinpatientswithestablishedCVdiseasesandinthosewithoutknowndiseaseaswellasevidencesupportingCRPasatargetoftherapy.Wealsoreviewvariouspharmacologic(especiallyintensivestatintherapy)andnonpharmacologictherapiestoreducelevelsofCRP.C-reactiveproteinandcardiovasculardiseases--isitreadyforprimetime?

第4頁,共31頁，2024年2月25日，星期天5AbstractOBJECTIVES:Thegoalofthissystematicreviewistoassessthecross-sectionalrelationshipofinflammatorymarkerswiththepresenceandextentofcoronaryarterycalcium(CAC)toidentifyasymptomaticindividualswithahigherriskofcoronaryheartdisease(CHD).BACKGROUND:Markersofsubclinicalinflammationandsubclinicalatherosclerosishavebothbeenusedtoimprovedetectionofindividualsathighriskofdevelopingcardiovasculardisease.CAChasemergedasasurrogatemakerforunderlyingcoronaryatherosclerosis,andhasbeenshowntopredictfutureCHDevents.Althoughinflammationisintimatelyassociatedwithatherosclerosis,andlevelsofinflammatorymarkerspredictcardiovascularrisk,therelationshipofsubclinicalinflammatorymarkerswiththeburdenofcoronaryatherosclerosisisnotclear.METHODS:MedlineandPubMeddatabasesweresearchedforallstudiesassessingtherelationshipofinflammatorymarkerswithCACpublishedtillJuly2007.RESULTS:Wefound12studiesthatmetourcriteria.CRP,fibrinogen,metallicmetalloproteinase-9(MMP-9),monocytechemotacticprotein1(MCP-1),resistin,lipoprotein-associatedphospholipaseA(2)(Lp-PLA(2)),IL-6,tumornecrosisfactoralpha(TNF-alpha)andbeta-fibroblastgrowthfactor(bFGF)wereusedasinflammatorymarkers.Therewasawidevariationamongstudieswithregardstopopulationsize,inclusioncriterias,agerangeandtechniques.ItwasobservedthatinalmostallstudiestherelationshipbetweeninflammatorymarkersandCACwasweak,andwasmostlyfounduponunivariateanalysisinwomen.However,thisassociationwaslostaftercorrectionforobesityandBMI.ThedataontherelationshipofinflammationandCACwithprogressionofatherosclerosisisscarceanddidnotshowanypredictivebenefitsforfutureCHD.CONCLUSION:VariableassociationsbetweenCACandinflammatorymarkerswereidentified.Inmoststudieswhereapositiverelationshipwasfound,thisrelationshipdisappearedafterappropriatecorrectionforthepresenceoftraditionalriskfactors.OurdatasuggeststhatanapproachinwhichinflammatorymarkersareusedtofurthercharacterizeriskinindividualswithanestablishedcoronaryarterydiseaseburdenismorewarrantedthanusingbiomarkersassoleriskpredictorsoffutureCHDevents.Large,well-plannedcomprehensivestudiesarerequiredtoidentifythecombinedroleofmeasuringinflammatorymarkersinassessmentofatheroscleroticdisease.Markersofinflammationandcoronaryarterycalcification:asystematicreview.

第5頁,共31頁，2024年2月25日，星期天6AbstractBACKGROUND:Traditionalriskfactorsdonotexplainalloftheriskforincidentcoronaryheartdisease(CHD)events.VariousneworemergingriskfactorshavethepotentialtoimproveglobalriskassessmentforCHD.PURPOSE:Tosummarizetheresultsof9systematicreviewsofnovelriskfactorstohelptheU.S.PreventiveServicesTaskForce(USPSTF)evaluatethefactors'clinicalusefulness.DATASOURCES:ResultsfromaMEDLINEsearchforEnglish-languagearticlespublishedfrom1966toSeptember2008,usingtheMedicalSubjectHeadingtermscohortstudiesandcardiovasculardiseasesincombinationwithtermsforeachriskfactor.STUDYSELECTION:Studieswereincludediftheparticipantshadnobaselinecardiovasculardiseaseandtheinvestigatorsadjustedforatleast6Framinghamriskfactors.DATAEXTRACTION:StudyqualitywasevaluatedbyusingUSPSTFcriteriaandoverallqualityofevidenceforeachriskfactorbyusingamodifiedversionoftheGradingofRecommendations,Assessment,Development,andEvaluationframework.Eachfactor'spotentialclinicalvaluewasevaluatedbyusingasetofcriteriathatemphasizedtheimportanceoftheeffectofthatfactoronthereclassificationofintermediate-riskpersons.DATASYNTHESIS:9systematicreviewswereconducted.C-reactiveprotein(CRP)wasthebestcandidateforuseinscreeningandthemostrigorouslystudied,butevidencethatchangesinCRPlevelleadtoprimarypreventionofCHDeventsisinconclusive.Theotherevaluatedriskfactorswerecoronaryarterycalciumscoreasmeasuredbyelectron-beamcomputedtomography,lipoprotein(a)level,homocysteinelevel,leukocytecount,fastingbloodglucose,periodontaldisease,ankle-brachialindex,andcarotidintima-mediathickness.Theavailabilityandvalidityoftheevidencevariedconsiderablyacrosstheriskfactorsintermsofaggregatequality,consistencyoffindings,andapplicabilitytointermediate-riskpersonsinthegeneralpopulation.Formostriskfactors,nostudiesassessedtheirusefulnessforreclassifyingintermediate-riskpersons.LIMITATIONS:Becauseoflackofaccesstooriginaldata,nofirmconclusionscouldbedrawnaboutdifferencesinriskpredictionamongracialandethnicgroups.Thereviewdidnotemphasizewithin-cohortcomparisonsofmultipleriskfactors.CONCLUSION:Thecurrentevidencedoesnotsupporttheroutineuseofanyofthe9riskfactorsforfurtherriskstratificationofintermediate-riskpersons.Emergingriskfactorsforcoronaryheartdisease:asummaryofsystematicreviewsconductedfortheU.S.PreventiveServicesTaskForce.

第6頁,共31頁，2024年2月25日，星期天7第7頁,共31頁，2024年2月25日，星期天8AbstractOBJECTIVE:Toassesstheoveralleffectsbyameta-analysis.DATASOURCES:ElectronicsearchesonPubMedandOvidMedlinefromtheirstarttoOctober2009werecarriedout.ObjectiveCohortstudiesandsecondaryanalysisofrandomisedcontrolledtrialsreportingtherelativerisk(RR)ofrecurrentcardiovasculareventsordeathassociatedwithC-reactiveprotein(CRP)obtainedwithin72hfromacutecoronarysyndromes(ACS)onset.DATAEXTRACTION:Twoepidemiologistsindependentlyabstractedinformationonstudydesign,studyandparticipantcharacteristics,levelofCRP,outcomes,controlforpotentialconfoundingfactorsandriskestimatesusingastandardisedform.RESULTS:Ageneralvariance-basedmethodwasusedtopooltheestimatesofrisk.Thirteenstudiescontaining1364newcasesidentifiedfrom9787patientsduringthefollow-upperiodsreportedtheriskestimatesbyCRPcategories.ComparedwiththebottomCRPcategory(<or=3mg/l),thepooledRRsandtheir95%CIswere1.40(1.18to1.67)forthemiddle(3.1approximately10mg/l)categoryand2.18(1.77to2.68)forthetop(>10mg/l)categoryofCRPvalueswitharandom-effectsmodel,respectively.AnotherfourandthreestudiesreportedtheriskbyunitofCRPorlogarithmicallytransformedCRP.ThepooledRRs(95%CI)were1.49(1.06to2.08)per5mg/land1.26(0.95to1.69)pernaturallogarithmofCRP(mg/l),respectively.CONCLUSIONS:GreaterearlybloodCRPmoderatelyincreaseslong-termriskofrecurrentcardiovasculareventsordeath,andmaybeavaluableprognosticpredictorinpatientsafterACS.EarlyC-reactiveproteininthepredictionoflong-termoutcomesafteracutecoronarysyndromes:ameta-analysisoflongitudinalstudies.

第8頁,共31頁，2024年2月25日，星期天9AbstractBACKGROUND:

AssociationsofC-reactiveprotein(CRP)concentrationwithriskofmajordiseasescanbestbeassessedbylong-termprospectivefollow-upoflargenumbersofpeople.WeassessedtheassociationsofCRPconcentrationwithriskofvascularandnon-vascularoutcomesunderdifferentcircumstances.METHODS:Wemeta-analysedindividualrecordsof160309peoplewithoutahistoryofvasculardisease(ie,1.31millionperson-yearsatrisk,27769fatalornon-fataldiseaseoutcomes)from54long-termprospectivestudies.Within-studyregressionanalyseswereadjustedforwithin-personvariationinriskfactorlevels.RESULTS:Log(e)CRPconcentrationwaslinearlyassociatedwithseveralconventionalriskfactorsandinflammatorymarkers,andnearlylog-linearlywiththeriskofischaemicvasculardiseaseandnon-vascularmortality.Riskratios(RRs)forcoronaryheartdiseaseper1-SDhigherlog(e)CRPconcentration(three-foldhigher)were1.63(95%CI1.51-1.76)wheninitiallyadjustedforageandsexonly,and1.37(1.27-1.48)whenadjustedfurtherforconventionalriskfactors;1.44(1.32-1.57)and1.27(1.15-1.40)forischaemicstroke;1.71(1.53-1.91)and1.55(1.37-1.76)forvascularmortality;and1.55(1.41-1.69)and1.54(1.40-1.68)fornon-vascularmortality.RRswerelargelyunchangedafterexclusionofsmokersorinitialfollow-up.Afterfurtheradjustmentforfibrinogen,thecorrespondingRRswere1.23(1.07-1.42)forcoronaryheartdisease;1.32(1.18-1.49)forischaemicstroke;1.34(1.18-1.52)forvascularmortality;and1.34(1.20-1.50)fornon-vascularmortality.INTERPRETATION:CRPconcentrationhascontinuousassociationswiththeriskofcoronaryheartdisease,ischaemicstroke,vascularmortality,anddeathfromseveralcancersandlungdiseasethatareeachofbroadlysimilarsize.TherelevanceofCRPtosucharangeofdisordersisunclear.Associationswithischaemicvasculardiseasedependconsiderablyonconventionalriskfactorsandothermarkersofinflammation.FUNDING:BritishHeartFoundation,UKMedicalResearchCouncil,BUPAFoundation,andGlaxoSmithKline.Copyright2010ElsevierLtd.Allrightsreserved.C-reactiveproteinconcentrationandriskofcoronaryheartdisease,stroke,andmortality:anindividualparticipantmeta-analysis.

第9頁,共31頁，2024年2月25日，星期天10不同類型文獻(xiàn)的主要區(qū)別

論著普通綜述系統(tǒng)綜述Meta分析數(shù)據(jù)基礎(chǔ)一次文獻(xiàn)二次或三次文獻(xiàn)二次文獻(xiàn)一次或二次文獻(xiàn)文獻(xiàn)檢索無特定標(biāo)準(zhǔn)無特定標(biāo)準(zhǔn)一定時(shí)間內(nèi)所有發(fā)表的文獻(xiàn)一定時(shí)間內(nèi)所有發(fā)表的文獻(xiàn)研究方法

有特定要求無特定要求有特定要求有特定要求研究結(jié)果基于原始數(shù)據(jù)分析定性總結(jié)對文獻(xiàn)研究結(jié)果的定性或定量綜合和陳述文獻(xiàn)研究數(shù)據(jù)定量綜合和陳述討論有無有有客觀質(zhì)量評價(jià)標(biāo)準(zhǔn)有無有有第10頁,共31頁，2024年2月25日，星期天傳統(tǒng)文獻(xiàn)綜述的缺陷主觀綜合缺乏標(biāo)準(zhǔn)化（可重復(fù)）的方法注重統(tǒng)計(jì)學(xué)是否“有意義”等價(jià)對待每篇文獻(xiàn)，無權(quán)重定性而非定量第11頁,共31頁，2024年2月25日，星期天12是準(zhǔn)確、可靠總結(jié)研究證據(jù)的工具，幫助臨床醫(yī)生、研究人員和病人了解最新的研究現(xiàn)狀；為政策制定者者判斷比較診斷、干預(yù)或治療方法的效果和危險(xiǎn)提供依據(jù)；臨床指南診治制定的依據(jù)；雜志編輯判斷投稿創(chuàng)新性的依據(jù)。系統(tǒng)綜述和Meta分析的功能第12頁,共31頁，2024年2月25日，星期天13經(jīng)文獻(xiàn)檢索數(shù)據(jù)庫查到的文獻(xiàn)篇數(shù)

其他來源的文獻(xiàn)篇數(shù)去除重復(fù)的文獻(xiàn)后的篇數(shù)參加篩選的文獻(xiàn)的篇數(shù)（摘要）排除的篇數(shù)

符合要求的文獻(xiàn)的篇數(shù)（全文）定性分析綜述的研究數(shù)量

排除的文獻(xiàn)（全文）和排除的理由定量分析的研究數(shù)量(meta-analysis)系統(tǒng)綜述和Meta分析流程圖第13頁,共31頁，2024年2月25日，星期天14好綜述的27條標(biāo)準(zhǔn)

PRISMA菜單（PreferredReportingItemsforSystematicreviews

andMeta-Analyses)題目:

1項(xiàng)標(biāo)準(zhǔn)摘要：1項(xiàng)標(biāo)準(zhǔn)前言：2項(xiàng)標(biāo)準(zhǔn)方法：12項(xiàng)標(biāo)準(zhǔn)結(jié)果：7項(xiàng)標(biāo)準(zhǔn)討論：3項(xiàng)標(biāo)準(zhǔn)經(jīng)費(fèi)：1項(xiàng)標(biāo)準(zhǔn)AlessandroLiberatietalAnnalsofInternalMedicine2009;151:W65-w94

第14頁,共31頁，2024年2月25日，星期天15●題目中應(yīng)說明是系統(tǒng)綜述或Meta分析舉例：1.C-reactiveproteinasariskfactorforcoronaryheartdisease:asystematicreviewandmeta-analysesfortheU.S.PreventiveServicesTaskForce.2.Markersofinflammationandcoronaryarterycalcification:asystematicreview.題目：1項(xiàng)標(biāo)準(zhǔn)第15頁,共31頁，2024年2月25日，星期天16●符合如下結(jié)構(gòu)和內(nèi)容：背景目標(biāo)資料來源研究入選標(biāo)準(zhǔn)、研究人群和干預(yù)措施評價(jià)和綜合研究結(jié)果的方法結(jié)果局限性結(jié)論和主要結(jié)果的意義系統(tǒng)綜述的注冊號摘要：1項(xiàng)標(biāo)準(zhǔn)第16頁,共31頁，2024年2月25日，星期天17●已現(xiàn)有知識為背景，說明了為什么要寫本篇綜述；●要綜述的研究問題明確（符合PICOS標(biāo)準(zhǔn)）前言：2項(xiàng)標(biāo)準(zhǔn)第17頁,共31頁，2024年2月25日，星期天18

P：研究對象（Participants)

I:

干預(yù)措施（Interventions)

C:

對照（Comparison)

O:結(jié)局（Outcome)

S:

研究設(shè)計(jì)(Studydesign)PICOS標(biāo)準(zhǔn)：第18頁,共31頁，2024年2月25日，星期天19●提供標(biāo)準(zhǔn)化的綜述方案（reviewprotocol)，最好有注冊號碼*●入選標(biāo)準(zhǔn)明確合理●說明所有文獻(xiàn)來源（文獻(xiàn)數(shù)據(jù)庫、其他文獻(xiàn)來源）●文獻(xiàn)檢索的策略正確（說明局限性，如不可復(fù)制的檢索方式）；●選擇研究的標(biāo)準(zhǔn)合理；●有資料收集或摘錄的程序（表格、獨(dú)立性、獲得原始數(shù)據(jù)的方法）●收集資料的內(nèi)容（應(yīng)列出所有采集的變量和定義）●應(yīng)對個體研究內(nèi)可能的偏倚進(jìn)行評價(jià)；●合并的測量指標(biāo)（如RR或均數(shù)差值）●結(jié)果合并的方法（統(tǒng)計(jì)學(xué)方法，如異質(zhì)性檢驗(yàn)、Meta分析的模型）●應(yīng)對研究間的偏倚進(jìn)行評價(jià)（如發(fā)表偏倚）●附加的分析方法（如敏感度分析、Meta回歸分析）

方法學(xué)：12項(xiàng)標(biāo)準(zhǔn)第19頁,共31頁，2024年2月25日，星期天發(fā)表偏倚（publicationbias）定位偏倚（locationbiases）引用偏倚（citationbias）多次發(fā)表偏倚（multiple

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