GRADE方法中,随机试验起评即为高质量证据,观察性研究起评即为低质量证据;但若证据本身存在高发表偏倚风险,则两者证据质量级别都应降低。即使最佳证据汇总表纳入的各项研究仅有低发表偏倚风险,发表偏倚仍会极大高估效应值。当可得证据来自小样本研究、且多数由厂商资助时,作者应怀疑存在发表偏倚。若干基于检验数据类型的方法可用于评价发表偏倚,其中最常用的为漏斗图,但这些方法都有较大局限。发表偏倚可能较常见,必须特别关注早期结果、对样本量与事件数都很小的早期试验结果尤需小心。
Citation: . GRADE guidelines: 5. Rating the quality of evidence—publication bias△. Chinese Journal of Evidence-Based Medicine, 2011, 11(12): 1430-1434. doi: 10.7507/1672-2531.20110242 Copy
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GRADE guidelines: 6. Rating the quality of evidence—imprecision△ GordonGuyatt, Andrew D. Oxman, Regina Kunz, Jan Brozek, Pablo AlonsoCoello, David Rind, PJ Devereaux, Victor M. Montori, Bo Freyschuss, Gunn Vist, Roman Jaeschke, John W. Williams Jr., Mohammad Hassan Murad, David Sinclairk, Yngve FalckYtter, Joerg Meerpohl, Craig Whittington, Kristian Thorlund, Jeff Andrews, Holger J. Schnemann, 代表GRADE工作组