实证医学.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,台湾,中山,醫學,大学,2015,年温州医科大学,PBL,教师研修团,9/18/2025,温医大附一院风湿免疫科,1,问题为教材,小组讨论为教学模式,学生为主角,自我学习,PBL=,Problem-based learning,（问题导向学习）,终身学习,群体合作,9/18/2025,温医大附一院风湿免疫科,2,小组学习,:Small Group Tutorial,9/18/2025,温医大附一院风湿免疫科,3,演讲目的,被动学习,一次学术会议,/,一次上课你能学到多少知识？,问题例题,lupus nephritis,Tacrolimus vs Cyclophosphamide,对降低蛋白尿，哪种药物疗效更好,?,打电话咨询其他医师？,上网百度？,看教科书或参考书？,3746,Lupus nephritis,Lupus nephritis Tacrolimus Cyclophosphamide,31,Clinical Study Categories,不同类型文章,描述型研究,前瞻性临床研究,随机、双肓、对照研究,观察型研究,分析型研究,大鱼？小鱼？,Clinical Study Categories,不同类型文章,如流行病学调查,某疾病的患病率,如肺癌与吸烟关系：,吸烟组,肺癌发病率,对照组,肺癌发病率,两组百分比相对比值,OR?,回顾性研究,病例对照研究,Case Control Study,肺癌,无肺癌,OR=3,有吸烟,无吸烟,有吸烟,无吸烟,疾病,病因,阶列研究结构模式,将来,现在（回顾性）,（回顾性研究）,a,b,c,d,暴露组发病率,非暴露组发病率,暴露,/,抽烟组,未暴露,/,无抽烟组,RR1 RR=1 RR1,病人,/,肺癌,非病人,/,无肺癌,病人,/,肺癌,非病人无肺癌,病因,疾病,入选人群随机分组,阶列研究结构模式,现在,将来（前瞻性）,队列研究,Cohort study,暴露组发病率,非暴露组发病率,（前瞻性研究）,a,b,c,d,RR=Ie/Io=1?,RD=Ie-Io=0?,meta,分析计数资料,四种模式,:,OR=Odds,ratio,RR=Relative,risk,RD=Risk,difference,HR=hazard ratio,1,(A/B)/(C/D),OR,meta,分析,荟萃分析,是对诸多（,RCT,）研究结果进行综合的一类统计方法,用统计学方法对收集的多个研究资料进行分析和概括,CNI,CYC,1.56 (1.14,2.15),1.23 (1.06,1.41),例题：临床问题,lupus nephritis,Tacrolimus vs Cyclophosphamide,对降低蛋白尿，哪种药物更有效,?,PICO,：,P,：,Patient/problem:,lupus nephritis patient,I,：,Intervention:,Tacrolimus,C,：,Comparator:Cyclophosphamide,O,：,Outcome:,降低蛋白尿,/,总疗效，哪个获益多？,康健外文医学期刊,医知网,Clinical Queries,目前免费、非常好！,Drugs&Diseases,相当于书籍,Lupus nephritis Tacrolimus Cyclophosphamide,Results:4 of 4,Meta-Analysis,Review,Customize,show 31 items,4 free full-text articles,Results:12,Free full text,Results:8,Lupus nephritis Tacrolimus Cyclophosphamide,42 Results,Systematic Reviews 5,5 Results,PICO search,Lupus nephritis,Tacrolimus,Cyclophosphamide,5 Results,Lupus nephritis Tacrolimus Cyclophosphamide,273,Lupus nephritis,Classes and,Classes and,Pharmacotherapy for Lupus Nephritis Based on Stage,Lupus nephritis,Tacrolimus,Cyclophosphamide,3,Complete remission,Partial remission,Total remission,1.56,（,1.14,2.15,）,0.97,（,0.70,1.33,）,1.23,（,1.08,1.42,）,1.23,（,1.08,1.41,）,CYC RR1,Liver function disorder,infection,Transient increase in SCr,Glucose disorder,Gastrointestinal symptoms,Irregular menstruation,Leucopenia,Overall,1.53,（,0.66,3.56,）,1.15,（,0.79,1.68,）,0.42,（,0.14,1.21,）,0.75,（,0.37,1.51,）,2.52,（,1.09,5.82,）,4.33,（,1.52,12.3,）,2.89,（,1.20,6.95,）,1.41,（,1.09,1.80,）,CYC RR1,TAC vs CsA RR=1.23,（,1.07,1.42,）,TAC vs CYC RR=1.22,（,1.05,1.41,）,CsA vs CYC RR=1.31,（,0.87,1.96,）,Complete remission rate,Partial remission rate,Response rate,RR Fixed 95%CI,1.61,（,1.17,2.23,）,0.96,（,0.68,1.33,）,1.26,（,1.09,1.44,）,CYC,TAC,Urine protein,Serum albumin,Anti-dsDNA,Std.Mean Difference,Fixed 95%CI,Std.Mean Difference,Random 95%CI,Risk Ratio,Fixed 95%CI,-0.52,（,-0.83,-0.22,）,1.11,（,0.17,2.06,）,1.34,（,1.01,1.78,）,TAC,TAC,TAC,CYC,P0.0001,Heterogeneity,P=0.75,Heterogeneity,P0.0001,Meta,分析齐性检验,heterogeneity,齐性检验,:,Fixedeffectmodel=,固定效应模型,分析结果,P,0.05,，为各研究同质性较好，用固定效应模型进行分析,Randomeffectmodel=,随机效应模型,分析结果,P,0.05,，为各研究同质性差，用随机效应模型进行分析。随机效应模型得出的结论置信区间较大,=,结果差异大,Serum C3,SLE-DAI,1.15,（,0.75,1.75,）,-0.69,（,-1.00,-0.19,）,TAC,CYC,CYC,TAC,本问题文献检索结论,lupus nephritis (LN,+,+),Tacrolimus vs Cyclophosphamide,完全缓解率：,TAC,CTX,部份缓解率：,TAC =,CTX,总的缓解率：,TAC,CTX,降低蛋白尿：,TAC,CTX,CyA =CTX,增高血清白蛋白：,TAC,CTX,SLE-DAI,：,TAC,CTX,抗,ds-DNA,：,TAC,CTX,补体,C3,：,TAC =,CTX,sCr,、,FBG,：,TAC =,CTX,56,Well,can we leave the matter there,then?I think thats all there is to say at present.,9/18/2025,温医大一院,风湿免疫科,小结：,提供三个免费网站,如何找到最好的文章,结,果,如何判读,