目的:系统评价祛痰/抗氧化药物治疗慢性阻塞性肺疾病(COPD)的疗效与安全性,为临床用药提供循证参考。方法:计算机检索PubMed、Embase、Cochrane图书馆、Web of Science、中国生物医学文献数据库、中国知网、维普网、万方数据等,收集祛痰...目的:系统评价祛痰/抗氧化药物治疗慢性阻塞性肺疾病(COPD)的疗效与安全性,为临床用药提供循证参考。方法:计算机检索PubMed、Embase、Cochrane图书馆、Web of Science、中国生物医学文献数据库、中国知网、维普网、万方数据等,收集祛痰/抗氧化药物(试验组)对比安慰剂(对照组)治疗COPD的随机对照试验(RCT),检索时限均为各数据库建库起至2021年5月。筛选文献、提取资料后采用Cochrane系统评价员手册5.1.0推荐的偏倚风险评价工具对纳入文献进行质量评价,采用Gemtc 14.3软件进行一致性检验,采用Stata 15.1软件进行网状Meta分析和聚类分层排序,采用倒漏斗图进行发表偏倚分析。结果:共纳入12项RCT,共计4637例患者,共涉及低剂量N-乙酰半胱氨酸(NAC)、高剂量NAC、羧甲司坦、厄多司坦、安慰剂等5种干预措施。网状Meta分析结果显示,在年急性加重率方面,试验组使用高剂量NAC[MD=-0.45,95%CI(-0.74,-0.17),P<0.05]、羧甲司坦[MD=-0.59,95%CI(-0.86,-0.32),P<0.05]、厄多司坦[MD=-0.26,95%CI(-0.51,-0.01),P<0.05]患者的年急性加重率均显著低于对照组,试验组使用高剂量NAC[MD=-0.55,95%CI(-0.98,-0.11),P<0.05]、羧甲司坦[MD=-0.69,95%CI(-1.11,-0.26),P<0.05]患者的年急性加重率均显著低于低剂量NAC,其余各组组间比较差异无统计学意义(P>0.05);网状Meta的概率累积排序结果(以曲线下面积计)为羧甲司坦>高剂量NAC>厄多司坦>安慰剂>低剂量NAC。在不良事件发生率方面,各组组间比较差异均无统计学意义(P>0.05);网状Meta的概率累积排序结果(以曲线下面积计)为厄多司坦>高剂量NAC>低剂量NAC>安慰剂>羧甲司坦。聚类分层排序结果显示,5种干预措施的疗效与安全性可聚为3类,其中疗效与安全性均较低的安慰剂和低剂量NAC为一类,疗效好但安全性低的羧甲司坦为一类,疗效与安全性均较好的高剂量NAC和厄多司坦为一类。发表偏倚结果显示,以年急性加重率为指标时,本研究存在发表偏倚的可能性较大,以不良事件发生率为指标时,本研究存在发表偏倚的可能性较小。结论:NAC、羧甲司坦、厄多司坦均可降低COPD患者的年急性加重率,且不会增加不良事件发生率。在年急性加重率方面,以羧甲司坦的效果最优;在安全性方面,以厄多司坦最好。高剂量NAC、厄多司坦的疗效与安全性均较好。展开更多
A personalized trustworthy service selection method is proposed to fully express the features of trust, emphasize the importance of user preference and improve the trustworthiness of service selection. The trustworthi...A personalized trustworthy service selection method is proposed to fully express the features of trust, emphasize the importance of user preference and improve the trustworthiness of service selection. The trustworthiness of web service is defined as customized multi-dimensional trust metrics and the user preference is embodied in the weight of each trust metric. A service selection method combining AHP （analytic hierarchy process） and PROMETHEE （preference ranking organization method for enrichment evaluations） is proposed. AHP is used to determine the weights of trust metrics according to users＇ preferences. Hierarchy and pairwise comparison matrices are constructed. The weights of trust metrics are derived from the highest eigenvalue and eigenvector of the matrix. to obtain the final rank of candidate services. The preference functions are defined according to the inherent characteristics of the trust metrics and net outranking flows are calculated. Experimental results show that the proposed method can effectively express users＇ personalized preferences for trust metrics, and the trustworthiness of service ranking and selection is efficiently improved.展开更多
文摘目的:系统评价祛痰/抗氧化药物治疗慢性阻塞性肺疾病(COPD)的疗效与安全性,为临床用药提供循证参考。方法:计算机检索PubMed、Embase、Cochrane图书馆、Web of Science、中国生物医学文献数据库、中国知网、维普网、万方数据等,收集祛痰/抗氧化药物(试验组)对比安慰剂(对照组)治疗COPD的随机对照试验(RCT),检索时限均为各数据库建库起至2021年5月。筛选文献、提取资料后采用Cochrane系统评价员手册5.1.0推荐的偏倚风险评价工具对纳入文献进行质量评价,采用Gemtc 14.3软件进行一致性检验,采用Stata 15.1软件进行网状Meta分析和聚类分层排序,采用倒漏斗图进行发表偏倚分析。结果:共纳入12项RCT,共计4637例患者,共涉及低剂量N-乙酰半胱氨酸(NAC)、高剂量NAC、羧甲司坦、厄多司坦、安慰剂等5种干预措施。网状Meta分析结果显示,在年急性加重率方面,试验组使用高剂量NAC[MD=-0.45,95%CI(-0.74,-0.17),P<0.05]、羧甲司坦[MD=-0.59,95%CI(-0.86,-0.32),P<0.05]、厄多司坦[MD=-0.26,95%CI(-0.51,-0.01),P<0.05]患者的年急性加重率均显著低于对照组,试验组使用高剂量NAC[MD=-0.55,95%CI(-0.98,-0.11),P<0.05]、羧甲司坦[MD=-0.69,95%CI(-1.11,-0.26),P<0.05]患者的年急性加重率均显著低于低剂量NAC,其余各组组间比较差异无统计学意义(P>0.05);网状Meta的概率累积排序结果(以曲线下面积计)为羧甲司坦>高剂量NAC>厄多司坦>安慰剂>低剂量NAC。在不良事件发生率方面,各组组间比较差异均无统计学意义(P>0.05);网状Meta的概率累积排序结果(以曲线下面积计)为厄多司坦>高剂量NAC>低剂量NAC>安慰剂>羧甲司坦。聚类分层排序结果显示,5种干预措施的疗效与安全性可聚为3类,其中疗效与安全性均较低的安慰剂和低剂量NAC为一类,疗效好但安全性低的羧甲司坦为一类,疗效与安全性均较好的高剂量NAC和厄多司坦为一类。发表偏倚结果显示,以年急性加重率为指标时,本研究存在发表偏倚的可能性较大,以不良事件发生率为指标时,本研究存在发表偏倚的可能性较小。结论:NAC、羧甲司坦、厄多司坦均可降低COPD患者的年急性加重率,且不会增加不良事件发生率。在年急性加重率方面,以羧甲司坦的效果最优;在安全性方面,以厄多司坦最好。高剂量NAC、厄多司坦的疗效与安全性均较好。
基金The National Natural Science Foundation of China(No.60973149)the Open Funds of State Key Laboratory of Computer Science of the Chinese Academy of Sciences(No.SYSKF1110)+1 种基金the Doctoral Fund of Ministry of Education of China(No.20100092110022)the College Industrialization Project of Jiangsu Province(No.JHB2011-3)
文摘A personalized trustworthy service selection method is proposed to fully express the features of trust, emphasize the importance of user preference and improve the trustworthiness of service selection. The trustworthiness of web service is defined as customized multi-dimensional trust metrics and the user preference is embodied in the weight of each trust metric. A service selection method combining AHP （analytic hierarchy process） and PROMETHEE （preference ranking organization method for enrichment evaluations） is proposed. AHP is used to determine the weights of trust metrics according to users＇ preferences. Hierarchy and pairwise comparison matrices are constructed. The weights of trust metrics are derived from the highest eigenvalue and eigenvector of the matrix. to obtain the final rank of candidate services. The preference functions are defined according to the inherent characteristics of the trust metrics and net outranking flows are calculated. Experimental results show that the proposed method can effectively express users＇ personalized preferences for trust metrics, and the trustworthiness of service ranking and selection is efficiently improved.
