中医药系统综述与Meta分析中异质性来源与处理——Meta回归在中医药领域的应用

Strategy for Addressing Heterogeneity in Systematic Reviews and Meta-analyses of Traditional Chinese Medicine: the Application of Meta-regression Approach

中医药系统综述与Meta分析中的临床异质性来源于可能导致不同研究间干预效果差异的某些因素,包括受试者、干预措施以及对照措施等方面。在进行中医药疗效和安全性系统综述与Meta分析时,必须采取适当措施对不同研究间的异质性进行检验、处理及解释。Meta回归是用来探索不同研究间异质性大小及来源的常用定量分析方法,可以探索不同中医临床研究间异质性的大小及来源,并进一步阐释异质性对Meta分析中合并效应的影响。对中医药疗效和安全性系统综述与Meta分析中的异质性概念、分类、来源以及常用检验方法 (包括图示法和定量统计分析方法),Meta回归(meta-regression)的概念、作用、优势及使用注意事项等进行了介绍,并以实例介绍了采用R语言的metafor包实现中医药疗效和安全性系统综述与Meta分析中异质性检验、Meta回归的具体操作过程和结果解读方法。

The clinical heterogeneity in systematic reviews(SRs)and meta-analyses of traditional Chinese medicine(TCM)originates from certain factors,such as participants,intervention and control,that may lead to intervention effects being different among each study. When SRs and meta-analyses are conducted to explore the effectiveness and safety of TCM,it is necessary to explore and deal with the between-study heterogeneity with appropriate approaches. Meta-regression is a quantitative method commonly used to explore the extent and source of between-study heterogeneity,as well as its impact on pooled effects. This paper introduces the definition,categories,and sources of heterogeneity,and summarizes the common methods used to address heterogeneity including graphical and quantitative statistical analyses. Meta-regression approach including its definition,function,advantages and precautions is also introduced. Moreover,an example of using metafor package of R language to explore the heterogeneity in SRs and metaanalyses of TCM has been taken,by providing the procedure steps and the interpretation of the results.