如何写好系统综述

关于如何写好系统综述第一页，共三十一页，2022年，8月28日写综述？写综述？第二页，共三十一页，2022年，8月28日2

综述的类型和特点

综述包括普通综述、系统综述和Meta分析：传统综述是常见的综述形式，为某一主题的文献结果的总结，但有逐渐被系统综述取代的可能性。系统综述是根据一定的入选标准,系统地整理所有相关的观察或实验研究的证据,以回答一个特定的研究问题。特点为（1）目标明确，方法学清晰且可复制；（2）进行了系统化的文献检索，包括符合入选标准的所有文献；（3）对文献可靠性进行了评价；（4）综合包括的文献的特征和研究结果并给予系统的陈述。Meta分析采用统计学的方法整合和总结所研究的文献的结果。系统综述可以包括Meta分析，也可以不包括。Meta分析与一般的系统综述相比，可以对干预效果进行更加准确的估计。

(CochraneCollaboration的定义)第三页，共三十一页，2022年，8月28日3AbstractC-reactiveprotein(CRP)isamarkerofsystemicinflammation,andithasbeenimplicatedinthepathogenesisofmanychronicdiseases,includingcardiovascular(CV)diseases.WithhighlysensitiveCRPassays,serumCRPcanaddconsiderablytostandardcoronaryheartdiseaseriskfactorsandinthepredictionofsubsequentmajorCVrisk.WereviewevidencesupportingtheassessmentofhighlysensitiveCRPbothinpatientswithestablishedCVdiseasesandinthosewithoutknowndiseaseaswellasevidencesupportingCRPasatargetoftherapy.Wealsoreviewvariouspharmacologic(especiallyintensivestatintherapy)andnonpharmacologictherapiestoreducelevelsofCRP.C-reactiveproteinandcardiovasculardiseases--isitreadyforprimetime?

第四页，共三十一页，2022年，8月28日4AbstractOBJECTIVES: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.

第五页，共三十一页，2022年，8月28日5AbstractBACKGROUND: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.

第六页，共三十一页，2022年，8月28日6第七页，共三十一页，2022年，8月28日7AbstractOBJECTIVE: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.

第八页，共三十一页，2022年，8月28日8AbstractBACKGROUND:

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.

第九页，共三十一页，2022年，8月28日9不同类型文献的主要区别

论著普通综述系统综述Meta分析数据基础一次文献二次或三次文献二次文献一次或二次文献文献检索无特定标准无特定标准一定时间内所有发表的文献一定时间内所有发表的文献研究方法

有特定要求无特定要求有特定要求有特定要求研究结果基于原始数据分析定性总结对文献研究结果的定性或定量综合和陈述文献研究数据定量综合和陈述讨论有无有有客观质量评价标准有无有有第十页，共三十一页，2022年，8月28日10传统文献综述的缺陷主观综合缺乏标准化（可重复）的方法注重统计学是否“有意义”等价对待每篇文献，无权重定性而非定量第十一页，共三十一页，2022年，8月28日是准确、可靠总结研究证据的工具，帮助临床医生、研究人员和病人了解最新的研究现状；为政策制定者者判断比较诊断、干预或治疗方法的效果和危险提供依据；临床指南诊治制定的依据；杂志编辑判断投稿创新性的依据。系统综述和Meta分析的功能第十二页，共三十一页，2022年，8月28日12经文献检索数据库查到的文献篇数

其他来源的文献篇数去除重复的文献后的篇数参加筛选的文献的篇数（摘要）排除的篇数

符合要求的文献的篇数（全文）定性分析综述的研究数量

排除的文献（全文）和排除的理由定量分析的研究数量(meta-analysis)系统综述和Meta分析流程图第十三页，共三十一页，2022年，8月28日13好综述的27条标准

PRISMA菜单（PreferredReportingItemsforSystematicreviews

andMeta-Analyses)题目:

1项标准摘要：1项标准前言：2项标准方法：12项标准结果：7项标准讨论：3项标准经费：1项标准AlessandroLiberatietalAnnalsofInternalMedicine2009;151:W65-w94

第十四页，共三十一页，2022年，8月28日14●题目中应说明是系统综述或Meta分析举例：1.C-reactiveproteinasariskfactorforcoronaryheartdisease:asystematicreviewandmeta-analysesfortheU.S.PreventiveServicesTaskForce.2.Markersofinflammationandcoronaryarterycalcification:asystematicreview.题目：1项标准第十五页，共三十一页，2022年，8月28日15●符合如下结构和内容：背景目标资料来源研究入选标准、研究人群和干预措施评价和综合研究结果的方法结果局限性结论和主要结果的意义系统综述的注册号摘要：1项标准第十六页，共三十一页，2022年，8月28日16●已现有知识为背景，说明了为什么要写本篇综述；●要综述的研究问题明确（符合PICOS标准）前言：2项标准第十七页，共三十一页，2022年，8月28日17

P：研究对象（Participants)

I:

干预措施（Interventions)

C:

对照（Comparison)

O:结局（Outcome)

S:

研究设计(Studydesign)PICOS标准：第十八页，共三十一页，2022年，8月28日18●提供标准化的综述方案（reviewprotocol)，最好有注册号码*●入选标准明确合理●说明所有文献来源（文献数据库、其他文献来源）●文献检索的策略正确（说明局限性，如不可复制的检索方式）；●选择研究的标准合理；●有资料收集或摘录的程序（表格、独立性、获得原始数据的方法）●收集资料的内容（应列出所有采集的变量和定义）●应对个体研究内可能的偏倚进行评价；●合并的测量指标（如RR或均数差值）●结果合并的方法（统计学方法，如异质性检验、Meta分析的模型）●应对研究间的偏倚进行评价（如发表偏倚）●附加的分析方法（如敏感度分析、Meta回归分析）

方法学：12项标准第十九页，共三十一页，2