系统评价应用于中医药领域中的问题与对策

Problems and countermeasures of systematic reviews in the field of traditional Chinese medicine

基于随机对照试验的系统评价与Meta分析作为循证医学体系中最高等级的证据,广泛应用于中医药领域。目前,中医药领域的系统评价研究已发表了14 000余篇,但尚存在一些问题。笔者试从临床问题构建、方法学设计以及成果报告等角度浅析当前中医药领域系统评价研究存在的问题,包括临床问题构建不当、缺失或偏离注册方案、文献检索不全面、未严格按照纳入排除标准进行文献筛选、合并效应量不当、缺乏发表偏倚评估、缺乏对利益冲突的报告等,并试述相关对策,以期为今后在中医药领域开展系统评价研究提供参考和借鉴。

As the highest level of evidence in the evidence-based medicine,systematic reviews(SRs)and Meta-analysis based on randomized controlled trials are now widely used in the field of traditional Chinese medicine(TCM).Up to now,about 14000 SRs of TCM have been published.However,there are still some problems in SRs of TCM.From the construction of clinical problem,methodological design and outcome report,this study attempts to analyze the existing problems of SRs in the field of TCM,including improper construction of clinical problems,lack or deviation of registration,incomplete literature retrieval,nonstandard literature screening,improper Meta-analysis,lack of publication bias assessment,lack of reports on conflicts of interest,and try to describe the relevant countermeasures,in order to provide recommendations for future research.