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异质性临床试验的Meta分析进展II:质量效应模型

Advances in the meta-analysis of heterogeneous clinical trials II: The quality effects model.

作者信息

Doi Suhail A R, Barendregt Jan J, Khan Shahjahan, Thalib Lukman, Williams Gail M

机构信息

Research School of Population Health, Australian National University, Canberra, Australia.

Epigear International, Sunrise Beach, Australia; School of Population Health, University of Queensland, Brisbane, Australia.

出版信息

Contemp Clin Trials. 2015 Nov;45(Pt A):123-9. doi: 10.1016/j.cct.2015.05.010. Epub 2015 May 21.

Abstract

This article examines the performance of the updated quality effects (QE) estimator for meta-analysis of heterogeneous studies. It is shown that this approach leads to a decreased mean squared error (MSE) of the estimator while maintaining the nominal level of coverage probability of the confidence interval. Extensive simulation studies confirm that this approach leads to the maintenance of the correct coverage probability of the confidence interval, regardless of the level of heterogeneity, as well as a lower observed variance compared to the random effects (RE) model. The QE model is robust to subjectivity in quality assessment down to completely random entry, in which case its MSE equals that of the RE estimator. When the proposed QE method is applied to a meta-analysis of magnesium for myocardial infarction data, the pooled mortality odds ratio (OR) becomes 0.81 (95% CI 0.61-1.08) which favors the larger studies but also reflects the increased uncertainty around the pooled estimate. In comparison, under the RE model, the pooled mortality OR is 0.71 (95% CI 0.57-0.89) which is less conservative than that of the QE results. The new estimation method has been implemented into the free meta-analysis software MetaXL which allows comparison of alternative estimators and can be downloaded from www.epigear.com.

摘要

本文考察了用于异质性研究荟萃分析的更新质量效应(QE)估计量的性能。结果表明,该方法在保持置信区间覆盖概率名义水平的同时,降低了估计量的均方误差(MSE)。大量模拟研究证实,无论异质性水平如何,该方法都能使置信区间保持正确的覆盖概率,并且与随机效应(RE)模型相比,观察到的方差更低。QE模型对于质量评估中的主观性具有鲁棒性,直至完全随机纳入,在这种情况下其MSE等于RE估计量的MSE。当将所提出的QE方法应用于镁对心肌梗死数据的荟萃分析时,合并死亡率比值比(OR)变为0.81(95%CI 0.61 - 1.08),这有利于较大规模的研究,但也反映了合并估计值周围不确定性的增加。相比之下,在RE模型下,合并死亡率OR为0.71(95%CI 0.57 - 0.89),不如QE结果保守。这种新的估计方法已被应用到免费的荟萃分析软件MetaXL中,该软件允许对不同的估计量进行比较,可从www.epigear.com下载。

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