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標題: | 系統性回顧及統合分析的研究方法釐清術後干擾素治療於肝癌病患的存活及幫助執行腹膜炎術後抗生素使用的臨床試驗 Systematic reviews and meta-analyses to clarify outcomes of adjuvant interferon therapy in hepatocellular carcinoma, and to help implement clinical trials of postoperative antibiotic use in secondary peritonitis |
作者: | Ting-Shuo Huang 黃挺碩 |
指導教授: | 陳培哲(Pei-Jer Chen) |
共同指導教授: | 陳祈玲(Chi-Ling Chen) |
關鍵字: | 系統性回顧,統合分析,硒,敗血症,干擾素,肝癌,血清降鈣素原,腹膜炎, systematic review,meta-analysis,selenium,sepsis,interferon,hepatocellular carcinoma,procalcitonin,peritonitis, |
出版年 : | 2014 |
學位: | 博士 |
摘要: | 系統性回顧及統合分析目前扮演了兩個很重要的角色,一個是針對臨床問題整合目前可獲得的最佳證據,對臨床決策提出建議,也就是實證醫學的臨床照護。另一方面,系統性回顧及統合分析在設計新的臨床試驗時也是不可或缺的,因為它可以幫忙決定是否下一個臨床試驗是必要的,如果統合分析的結果已經有確證,那下個臨床試驗就不應該做。如果沒有確證,那系統性回顧及統合分析的結果可以提供下一個臨床試驗寶貴的資料。因此,我們把這些概念應用於三個臨床研究。第一個研究是我們利用此研究方法探討一個未解決的問題:重症病患靜脈注射硒的輔助治療是否可以改善死亡率。我們發現硒補充治療可以降低重症敗血症病患的死亡且治療時間愈長效果愈好,這個發現有機會提供重症敗血症病人的新治療方式。第二個研究是探討一直有爭議的問題:輔助性干擾素治療用於病毒性肝炎病患發生肝癌且接受根除性治療後是否會延長存活。我們的統合分析發現了干擾素是可以增進C肝病人存活的,但B肝的病人則沒有證據顯示出有療效,所以之前的統合分析不管臨床的異質性把所有收納B肝及C肝病人的隨機對照試驗和非隨機對照試驗結合起來就造成假的結果。第三個研究我們利用系統性回顧及統合分析的結果設計並執行一個臨床試驗來探討血清降鈣素原的治療指引是否可以減少腹膜炎術後抗生素的使用。我們這個研究顯示出血清降鈣素原治療指引和實證指引比較起來,顯著的降低腹膜炎術後暴露在抗生素使用的風險,且不會增加併發症的發生。因此系統性回顧及統合分析的研究方法本質是屬於執行科學的方法的一部分,可以提供臨床照護及研究者及時的實證醫學證據。 Systematic reviews (SRs) and meta-analyses (MAs) offer more information than individual studies for benefits or harms of interventions and are of crucial important to the advance of evidence-based health care and designs of clinical trials High-quality SRs and MAs could summarize up-to-date evidence for clinical practice and provide useful information for designs of clinical trials. In addition, they could determine whether the next clinical trials are needed. Here we applied such strategies to perform three studies. First, we conducted a SR and MA to investigate parenteral selenium supplementation for critically ill patients. We were the first study to demonstrate that parenteral selenium supplementation significantly reduces all-cause mortality among critically ill patients with SIRS or sepsis, particularly those who were treated more than 7 days. Second, adjuvant interferon therapy for viral hepatitis-related hepatocellular carcinoma is controversial. We conducted a SR and MA and showed that adjuvant interferon treatment significantly improves the recurrence-free survival and overall survival among patients with hepatitis C virus-related hepatocellular carcinoma (HCC). However, there was little evidence of beneficial effects for hepatitis B virus-related HCC. Third, we used information from SRs and MAs to design and conduct a clinical trial of a procalcitonin-based algorithm to guide antibiotic use in secondary peritonitis. Our prospective study indicated that the procalcitonin-guided algorithm, compared to the standard of care, significantly reduced the hazard of antibiotic exposure among patients with secondary peritonitis following emergency surgery without increasing the risk of adverse events. Incorporating systematic reviews and meta-analyses in the research frameworks is a scientific method in context, and it could provide timely evidence for evidence-based health care and trial designs. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/58722 |
全文授權: | 有償授權 |
顯示於系所單位: | 臨床醫學研究所 |
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