統合分析是將一些議題相關但彼此獨立的臨床實驗之研究結果(大都取材於已發表之期刊論文)，以量性加權平均的方法結合統整，用來代表此議題現階段之研究結果，據此評估療效或草擬新的臨床實驗之依據。常用之統合分析方法依資料特性有: 二元資料之相對危險度(Relative Risk)、勝算比(Odds Ratio)及率差(Rates Difference)；常態分佈資料之效應量(Effect Size)及統合回歸(Meta Regression)等。至於臨床醫學診斷常用之ROC曲線圖形下面積的統合分析方法，至今尚未被提出。
    青光眼是不可逆的視神經病變，其疾病的特色就是漸進性的視神經纖維層(Retinal Nerve Fiber Layer，RNFL)厚度的變薄，其嚴重度可以客觀的由影像檢查儀進行評估，目前眼科是以光電同調斷層掃描儀(Optical Coherence Tomography，OCT)為主。現今發表之文獻以OCT診斷青光眼之診斷力呈現顯著之異質性，所用診斷力指標常以靈敏度(Sensitivity)、特異性(Specificity)及ROC曲線圖形下面積呈現。據此，以隨機效應之統合分析方法，綜合ROC曲線圖形下面積，將有助於呈現以OCT診斷青光眼之整體診斷力。本研究計畫將提出ROC曲線圖形下面積之固定及隨機效應的統合分析方法，並將之應用在以OCT診斷青光眼的研究議題。

Meta-analysis is a quantitative weighted average method to combine the results of related but independent studies (usually drawn from the published literatures) and synthesize summaries and conclusions which may be used to evaluate the therapeutic effects and/or plain new study accordingly. The commonly used meta-analyses, dependent on the characteristic of data, are: the relative risk, odds ratio, and rates difference for binary data and effect size and meta-regression for normally distributed data. Meta-analysis for area under ROC curve (AUC), a commonly used medical diagnosis method, has not been proposed yet. 
    Glaucoma is an irreversible optic neuropathy, which characterized by progressive retinal nerve fiber layer (RNFL) thinning. Its severity could be evaluated objectively by imaging techniques which mainly by optical coherence tomography (OCT) in current ophthalmology. The diagnostic capacities of OCT for glaucoma were heterogeneous in the current published literatures. Most of them were presented in terms of sensitivity, specificity, and area under ROC curve (AUC). Accordingly, a random effects’ meta-analysis for AUC will be helpful to synthesize the overall diagnostic capacities of OCT for glaucoma. In this study, we are going to propose a fixed/random effects meta-analysis method for area under ROC curve and apply it to glaucoma diagnostic by OCT.

中文摘要	I
ABSTRACT	II
致謝	III
目錄	IV
圖目錄	V

第一章 緒論	1
  第一節 研究背景及目的	1
  第二節 研究問題	2
第二章 統合分析	4
  第一節 前言	4
  第二節 研究步驟	5
  第三節 統計方法	6
  第四節 統合分析的優點	12
  第五節 結論	12
第三章 研究方法	13
  第一節 效果量計算	13
  第二節 資料分析	15
第四章 研究結果	16
  第一節 研究基本資料	16
  第二節 Funnel Plot	17
  第三節 研究結果	21
第五章 結論與建議	47

參考文獻	48

圖目錄
圖1.2.1：OCT眼球診斷方位相對位置	3
圖4.2.1：Cirrus儀器在Superior方位所測得AUC值的funnel plot	17
圖4.2.2：Cirrus儀器在Nasal方位所測得AUC值的funnel plot	17
圖4.2.3：Cirrus儀器在Inferior方位所測得AUC值的funnel plot	18
圖4.2.4：Cirrus儀器在Temporal方位所測得AUC值的funnel plot	18
圖4.2.5：Cirrus儀器在Average方位所測得AUC值的funnel plot	18
圖4.2.6：Stratus儀器在Superior方位所測得AUC值的funnel plot	19
圖4.2.7：Stratus儀器在Nasal方位所測得AUC值的funnel plot	19
圖4.2.8：Stratus儀器在Inferior方位所測得AUC值的funnel plot	19
圖4.2.9：Stratus儀器在Temporal方位所測得AUC值的funnel plot	20
圖4.2.10：Stratus儀器在Average方位所測得AUC值的funnel plot	20
圖4.3.11：CirrusSuperior在固定效應下之forest plot	21
圖4.3.12：CirrusSuperior在隨機效應下之forest plot	22
圖4.3.13：CirrusNasal在固定效應下之forest plot	23
圖4.3.14：CirrusNasal在隨機效應下之forest plot	24
圖4.3.15：CirrusInferior在固定效應下之forest plot	25
圖4.3.16：CirrusInferior在隨機效應下之forest plot	26
圖4.3.17：CirrusTemporal在固定效應下之forest plot	27
圖4.3.18：CirrusTemporal在隨機效應下之forest plot	28
圖4.3.19：CirrusAverage在固定效應下之forest plot	29
圖4.3.20：CirrusAverage在隨機效應下之forest plot	30
圖4.3.21：StratusSuperior在固定效應下之forest plot	33
圖4.3.22：StratusSuperior在隨機效應下之forest plot	33
圖4.3.23：StratusNasal在固定效應下之forest plot	36
圖4.3.24：StratusNasal在隨機效應下之forest plot	36
圖4.3.25：StratusInferior在固定效應下之forest plot	39
圖4.3.26：StratusInferior在隨機效應下之forest plot	39
圖4.3.27：StratusTemporal在固定效應下之forest plot	42
圖4.3.28：StratusTemporal在隨機效應下之forest plot	42
圖4.3.29：StratusAverage在固定效應下之forest plot	45
圖4.3.30：StratusAverage在隨機效應下之forest plot	45
 
表目錄
表4.3.1：CirrusSuperior在固定效應下之分析	21
表4.3.2：CirrusSuperior在隨機效應下之分析	22
表4.3.3：CirrusNasal在固定效應下之分析	23
表4.3.4：CirrusNasal在隨機效應下之分析	24
表4.3.5：CirrusInferior在固定效應下之分析	25
表4.3.6：CirrusInferior在隨機效應下之分析	26
表4.3.7：CirrusTemporal在固定效應下之分析	27
表4.3.8：CirrusTemporal在隨機效應下之分析	28
表4.3.9：CirrusAverage在固定效應下之分析	29
表4.3.10：CirrusAverage在隨機效應下之分析	30
表4.3.11：StratusSuperior在固定效應下之分析	31
表4.3.12：StratusSuperior在隨機效應下分析	32
表4.3.13：StratusNasal在固定效應下之分析	34
表4.3.14：StratusNasal在隨機效應下之分析	35
表4.3.15：StratusInferior在固定效應下之分析	37
表4.3.16：StratusInferior在隨機效應下分析	38
表4.3.17：StratusTemporal在固定效應下之分析	40
表4.3.18：StratusTemporal在隨機效應下之分析	41
表4.3.19：StratusAverage在固定效應下之分析	43
表4.3.20：StratusAverage在隨機效應下之分析	44
表4.3.21：固定效應模式下之各研究效應量表	46
表4.3.22：隨機效應模式下之各研究效應量表	46

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