临床研究证据分级及评价

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2009914ChinJEvidBasedCardiovascMed,September2009,Vol.1,No.4[]R4[]C[]167424055(2009)0420247204,,,,,[1],[2],?,,;;,[3]1.:,,,,,,,,,,,(cardiacarrhythmiasup2pressiontrial,CAST)1489(AMI),(flecainide)/(encainide):100191,:,Email:siyan2zhan@bjmu.edu.cndoi:10.3785/j.issn.167424055.2009.04.019,9.7:7.7%,3.0%,AMI,/70%,90%,2CAST2,CAST,(moracizine),14d,CAST2CAST,[4](randomizedcontrolledtrial,RCT),,,,;,2.:,,,(systematicreviews,SR)/meta/meta,,,(clinicalpracticeguidelines,CPG),,,,,,,7422009914ChinJEvidBasedCardiovascMed,September2009,Vol.1,No.4(handbookofclinicalevidence),,,4S,(healthtechnologyassessment,HTA),()(222)(),(healtheconomics),,?,[5]20015(1),5,A()B()C()D()4A,,,,;BC,;D[6](1),(thegradingofrecommenda2tionsassessmentdevelopmentandevaluationworkinggroup,GRADE)2000GRADE2004,4[7],,,[8]GRADE,()();,,,,Cochrane(WHO)(BMJ)20085GRADE,[8212],1(//)A1a3RCT1bRCT()1c(,)B2a2b(RCT,:80%)2c:3a3bC4()D5,:3:,8422009914ChinJEvidBasedCardiovascMed,September2009,Vol.1,No.4,RCT[13]:(1):??????,?,?(2):?(20%,10%)??(3):,RCT/meta:(1),????(2),?,,,,,,,:(1)12?(2)?,A,;B,,,;CD,,,,,,,,[14]1.,:(1)????,?(2)??,[13]?2.,:(1)?,;???,???(2),(15)(50%)(KaplanMeier),?95%?(3)?[13]?3.,:(1)?,???????(2)??(3)?????[13]?,,,,,,,[1],..,2002,2:2052208.[2],..,2009,1:1232126.9422009914ChinJEvidBasedCardiovascMed,September2009,Vol.1,No.4[3]..:,2003.17219.[4],..,2008,1:9212.[5],,..,2008,8:1272133.[6]PhillipsB,BallC,SackettD,etal.LevelsofevidenceandGradesofrecommendations.Availableat(accessedJune2006).[7]AtkinsD,BestD,BrissPA,etal.Gradingqualityofevidenceandstrengthofrecommendations.BMJ,2004,328:149021494.[8]GuyattGH,OxmanAD,VistGE,etal.GRADE:anemergingcon2sensusonratingqualityofevidenceandstrengthofrecommenda2tions.BMJ,2008,336:9242926.[9]GuyattGH,OxmanAD,KunzR,etal.Whatisqualityofevi2denceandwhyisitimportanttoclinicians?BMJ,2008,336:9952998.[10]GuyattGH,OxmanAD,KunzR,etal.Goingfromevidencetorec2ommendations.BMJ,2008,336:104921051.[11]SchnemannHJ,OxmanAD,BrozekJ,etal.Gradingqualityofev2idenceandstrengthofrecommendationsfordiagnostictestsandstrategies.BMJ,2008,336:110621110.[12]GuyattGH,OxmanAD,KunzR,etal.Incorporatingconsiderationsofresourcesuseintogradingrecommendations.BMJ,2008,336:117021173.[13]..:,2006.1572164.[14]..2.:,2006.1612162.(:2009207211:2009207225)BARI2D22?22(ARandom2izedTrialofTherapiesforType2DiabetesandCoronaryArteryDisease,TheBARI2DStudyGroup,BARI2D),BARI2D23682,2,PCICABG,2.0mg/dl(177mol/L),13.0%,,,12PCICABG();(7.0),,,():,3112(MB,)PCICABGMB310Minnesota2Q;5,(88.3%87.8%,P=0.97),(88.2%87.9%,P=0.89):77.2%,75.9%,P=0.70;77.7%,75.4%,P=0.13PCI,,CABG,(22.4%),30.5%,P=0.01,(9.2%),(5.9%,P=0.003)BARI2D:,,(FromNEnglJMed,2009,360:250322515)052

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