系统综述与 Meta 分析

示意意见 · 非真实审稿意见

The pooled analysis shows substantial heterogeneity (I²=68%), yet the authors proceed with pooling without adequate exploration of heterogeneity sources. Meta-regression was not performed, and the subgroup analyses were not pre-specified in the protocol. The clinical validity of pooling these studies remains questionable.

预防策略：在 PICOS 设计阶段预设至少 3 类亚组分析（按研究人群、干预剂量/时长、随访时间）和 Meta 回归变量（如发表年份、样本量、偏倚风险等级）。主分析效应模型按方案预先设定，不因 I² 数值切换；同时报告 I² 与 τ²，随机效应分析附 prediction interval 说明效应量的可能分布范围。在方法节明确说明"亚组和 Meta 回归计划在 PROSPERO 中预注册"。

示意意见 · 非真实审稿意见

The authors only searched PubMed and Cochrane. Major databases such as Embase and Web of Science were not included, which may have led to selective inclusion of studies. Additionally, grey literature and conference abstracts were not searched, raising concerns about publication bias beyond what funnel plots can detect.

预防策略：标准检索策略覆盖 PubMed + Embase + Cochrane + Web of Science 四库，并补充 ClinicalTrials.gov 注册研究（识别未发表数据）。检索策略附完整语句作为附件（Supplementary Table S1）。PRISMA 流程图中单独列出"数据库检索"和"灰色文献检索"两个枝干的记录数。

示意意见 · 非真实审稿意见

The authors conclude the evidence is of "moderate quality," but no GRADE assessment table is provided. The basis for upgrading or downgrading the evidence level is not transparent, making it impossible to evaluate whether the overall confidence rating is appropriate.

预防策略：使用 GRADEpro GDT 工具生成标准 GRADE 证据表，在五个维度逐一说明降级（或升级）依据。GRADE 表以正文表格呈现或作为在线附件提交。结论节的表述应与 GRADE 等级一致，证据等级为 "low quality" 时不应使用 "the evidence strongly supports" 等表述。