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审核状态: Project audit state: |
通过审核 Successful |
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注册号: Registration number: |
ChiCTR2600122434 |
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最近更新日期: Date of Last Refreshed on: |
2026-04-14 09:10:52 |
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注册时间: Date of Registration: |
2026-04-14 00:00:00 |
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注册号状态: |
预注册 |
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Registration Status: |
Prospective registration |
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注册题目: |
抗生素降阶梯治疗治疗社区获得性肺炎:一项多中心、开放标签、非劣效、随机对照流床试验 |
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Public title: |
Antibiotic Step-down Therapy for Community-Acquired Pneumonia: A Multicenter, Open-Label, Non-Inferiority, Randomized Controlled Clinical Trial |
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注册题目简写: |
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English Acronym: |
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研究课题的正式科学名称: |
抗生素降阶梯治疗治疗社区获得性肺炎:一项多中心、开放标签、非劣效、随机对照流床试验 |
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Scientific title: |
Antibiotic Step-down Therapy for Community-Acquired Pneumonia: A Multicenter, Open-Label, Non-Inferiority, Randomized Controlled Clinical Trial |
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研究课题代号(代码): Study subject ID: |
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在二级注册机构或其它机构的注册号: The registration number of the Partner Registry or other register: |
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申请注册联系人: |
陈子漩 |
研究负责人: |
林盪 |
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Applicant: |
Chen Zixuan |
Study leader: |
Lin Dang |
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申请注册联系人电话: Applicant telephone: |
+86 13174518189 |
研究负责人电话:
Study leader's |
+86 512 62364067 |
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申请注册联系人传真 : Applicant Fax: |
研究负责人传真: Study leader's fax: |
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申请注册联系人电子邮件: Applicant E-mail: |
czxdoct@163.com |
研究负责人电子邮件: Study leader's E-mail: |
lind69@163.com |
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申请单位网址(自愿提供): Applicant website(voluntary supply): |
研究负责人网址(自愿提供): Study leader's website(voluntary supply): |
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申请注册联系人通讯地址: |
中国江苏省苏州市白塔西路16号 |
研究负责人通讯地址: |
中国江苏省苏州市姑苏区道前街26号 |
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Applicant address: |
No. 16, West Baita Road, Suzhou, Jiangsu, China |
Study leader's address: |
26 Daoqian Street, Gusu District, Suzhou, Jiangsu, China |
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申请注册联系人邮政编码: Applicant postcode: |
研究负责人邮政编码: Study leader's postcode: |
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申请人所在单位: |
苏州市立医院 |
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Applicant's institution: |
The Affiliated Suzhou Hospital Of Nanjing Medical University |
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研究负责人所在单位: |
苏州市立医院 |
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Affiliation of the Leader: |
Suzhou Municipal Hospital |
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是否获伦理委员会批准: |
是 |
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Approved by ethic committee: |
Yes |
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伦理委员会批件文号: Approved No. of ethic committee: |
K-2026-059-K01 |
伦理委员会批件附件: Approved file of Ethical Committee: |
查看附件View |
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批准本研究的伦理委员会名称: |
苏州市立医院伦理委员会 |
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Name of the ethic committee: |
Ethics Committee Suzhou Municipal Hospital |
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伦理委员会批准日期: Date of approved by ethic committee: |
2026-02-27 00:00:00 | ||
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伦理委员会联系人: |
周蓦 |
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Contact Name of the ethic committee: |
Zhou Mo |
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伦理委员会联系地址: |
中国江苏省苏州市姑苏区道前街26号 |
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Contact Address of the ethic committee: |
26 Daoqian Street, Gusu District, Suzhou, Jiangsu, China |
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伦理委员会联系人电话: Contact phone of the ethic committee: |
+86 512 62362550 |
伦理委员会联系人邮箱: Contact email of the ethic committee: |
szslyyec@163.com |
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研究实施负责(组长)单位: |
苏州市立医院 |
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Primary sponsor: |
Suzhou Municipal Hospital |
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研究实施负责(组长)单位地址: |
中国江苏省苏州市姑苏区道前街26号 |
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Primary sponsor's address: |
26 Daoqian Street, Gusu District, Suzhou, Jiangsu, China |
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试验主办单位(项目批准或申办者): Secondary sponsor: |
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经费或物资来源: |
苏州市科教强卫项目 |
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Source(s) of funding: |
Suzhou Science and Education for Health Enhancement Project |
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研究疾病: |
社区获得性肺炎 |
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Target disease: |
community-acquired pneumonia |
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研究疾病代码: |
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Target disease code: |
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研究类型: |
干预性研究 |
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Study type: |
Interventional study |
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研究所处阶段: |
其它 | ||||||||||||||||||||||
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Study phase: |
N/A |
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研究设计: |
随机平行对照 |
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Study design: |
Parallel |
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研究目的: |
1. 通过随机对照研究,针对非重症社区获得性肺炎住院患者,与标准7天抗生素治疗相比,评估3天抗生素短疗程治疗的有效性及安全性。 2. 根据患者临床特征进行亚组分析,识别适用于3天抗生素短疗程社区获得性肺炎住院患者特征。 |
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Objectives of Study: |
1. To evaluate the efficacy and safety of 3-day short-course antibiotic therapy compared with standard 7-day antibiotic therapy in hospitalized patients with non-severe community-acquired pneumonia via a randomized controlled trial. 2. To perform subgroup analyses based on patients’ clinical characteristics and identify the characteristics of hospitalized patients with community-acquired pneumonia who are suitable for 3-day short-course antibiotic therapy. |
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药物成份或治疗方案详述: |
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Description for medicine or protocol of treatment in detail: |
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纳入标准: |
1. 年龄≥18岁且<75岁,性别不限; 2. 初诊明确诊断为CAP且影像学示单肺叶浸润。CAP诊断标准:符合以下1、2条件以及条件3中任何1项,并除外肺结核、肺部肿瘤、非感染性肺间质性疾病、肺水肿、肺不张、肺栓塞、肺嗜酸粒细胞浸润症及肺血管炎。 (1) 社区发病。 (2) 胸部影像学检查显示新出现的斑片状浸润影、叶或段实变影、磨玻璃影或间质性改变,伴或不伴胸腔积液。 (3) 肺炎相关临床表现: 1) 新近出现的咳嗽、咳痰或原有呼吸道疾病症状加重,伴或不伴脓痰、胸痛、呼吸困难及咯血; 2) 发热; 3) 肺实变体征和(或)闻及湿性啰音; 4) 外周血白细胞>10×10^9/L或<4×10^9/L,伴或不伴细胞核左移。 3. 非重症CAP患者,定义为不符合重症标准的CAP患者。重症肺炎诊断标准:符合以下1/2主要标准,或3/9项次要标准。 (1) 主要标准: 1) 需要气管插管行机械通气治疗; 2) 脓毒症休克经积极液体复苏后仍需要血管活性药物治疗; (2) 次要标准: 1) 呼吸频率≥30次/min; 2) 氧合指数≤250mmHg; 3) 多肺叶浸润; 4) 意识障碍和/或定向障碍; 5) 血尿素氮≥7.14mmol/L; 6) 收缩压<90mmHg; 7) 白细胞减少(<4.0×10^9/L); 8) 血小板减少(<10×10^9/L); 9) 低体温(核心体温<36℃); 4. CURB-65评分为0-1分; 5. 怀疑细菌感染可能:外周血白细胞>10×10^9/L或胸部影像学显示新发肺叶/段实变影或脓性痰或CRP≥50 mg/L或PCT≥0.25ng/ml,满足其中之一; 6. 无耐药细菌(包括耐甲氧西林金黄色葡萄球菌、多重耐药肠杆菌目细菌、铜绿假单胞菌及其他多重耐药革兰氏阴性杆菌)感染的高危因素 ——即满足肺炎耐药(DRIP)评分<4分; 7. 自愿参加研究并签署知情同意书,或由其法定授权代表提供知情同意书。 |
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Inclusion criteria |
1. Age >= 18 years and < 75 years, regardless of gender; 2. Initial diagnosis of definite community-acquired pneumonia (CAP) with imaging showing single lobar infiltration. Diagnostic Criteria for CAP: meet criteria 1 and 2, plus any one item in criterion 3, and rule out tuberculosis, pulmonary neoplasms, non-infectious interstitial lung diseases, pulmonary edema, atelectasis, pulmonary embolism, pulmonary eosinophilic infiltration, and pulmonary vasculitis. (1) Onset in the community. (2) Chest imaging reveals newly developed patchy infiltrates, lobar or segmental consolidation, ground-glass opacities, or interstitial changes, with or without pleural effusion. (3) Pneumonia-related clinical manifestations: 1) New onset of cough, expectoration, or worsening of pre-existing respiratory symptoms, with or without purulent sputum, chest pain, dyspnea, and hemoptysis; 2) Fever; 3) Signs of pulmonary consolidation and/or auscultatory crackles; 4) Peripheral blood leukocyte count > 10 x 10^9/L or < 4 x 10^9/L, with or without left shift of neutrophils. 3. Patients with non-severe community-acquired pneumonia (CAP) are defined as CAP patients who do not meet the criteria for severe pneumonia. Diagnostic Criteria for Severe Pneumonia: Meet 1 of the 2 major criteria or 3 of the 9 minor criteria. (1) Major Criteria: 1) Requirement for endotracheal intubation and mechanical ventilation. 2) Septic shock requiring vasopressor therapy despite aggressive fluid resuscitation. (2) Minor Criteria: 1) Respiratory rate >= 30 breaths/min; 2) Oxygenation index (PaO2/FiO2) <= 250 mmHg; 3) Multilobar pulmonary infiltrates; 4) Disturbance of consciousness and/or disorientation; 5) Blood urea nitrogen >= 7.14 mmol/L; 6) Systolic blood pressure < 90 mmHg; 7) Leukopenia (< 4.0 x 10^9/L); 8) Thrombocytopenia (< 10 x 10^9/L); 9) Hypothermia (core body temperature < 36℃). 4. CURB-65 score 0–1; 5. Presumed possible bacterial infection, meeting at least one of the following: Peripheral blood white blood cell count > 10 x 10^9/L, New lobar or segmental consolidation on chest imaging, Purulent sputum, CRP >= 50 mg/L, PCT >= 0.25 ng/mL; 6. No high-risk factors for infection with drug-resistant bacteria (including Methicillin-resistant Staphylococcus aureus, multidrug-resistant Enterobacterales, Pseudomonas aeruginosa, and other multidrug-resistant Gram-negative bacilli), i.e., Drug-Resistant in Pneumonia (DRIP) score < 4; 7. Voluntary participation in the study with signed informed consent, or informed consent provided by their legally authorized representative; |
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排除标准: |
1. 已知对头孢菌素、大环内酯类药物、喹诺酮类药物、四环素类药物过敏者; 2. 入院前7天使用抗生素超过24小时;60天内曾从医疗机构出院或过去3年有3次以上住院史的患者; 3. 入院时血氧饱和度<90%; 4. 需要同时进行可能对 CAP 病原体有效的全身抗菌治疗; 5. 怀疑或确诊病毒性、军团菌、金黄色葡萄球菌或铜绿假单胞菌肺炎; 6. 有肺浸润的非感染性原因(如肺栓塞、误吸引起的化学性肺炎、过敏性肺炎、充血性心力衰竭、支气管阻塞、肺癌、囊性纤维化); 7. 确诊或疑似脓胸; 8. 患有慢性阻塞性肺疾病或哮喘; 9. 患有脑血管疾病(脑梗死、脑出血、脑血管畸形); 10. 患有或有发生重大心脏事件或功能障碍的风险,包括但不限于以下内容: (1) 已知的QT 间期延长或长QT 综合征家族史。 (2) 随机分组前未治疗的有临床意义的低钾血症。 (3) 临床不稳定的心脏病,包括不稳定的心房颤动、有症状的心动过缓、不稳定的充血性心力衰竭、活动性心肌缺血或留置起搏器。 (4) 完全性左束支传导阻滞; 11. 肾功能严重受损,定义为肌酐清除率 (CrCl) <= 30 mL/min,根据 CockcroftGault 公式计算; 12. 合并有影响社区获得性肺炎治疗预后的高危因素; 高危因素包括: (1) 低氧血症 ; (2) 酸中毒; (3) 低血压(收缩压<90mmHg); (4) 胸腔积液; (5) 低体温(体温<36℃); (6) 多肺叶受累; (7) 影像学空洞; 13. 有重大肝脏、血液学疾病的证据,包括以下任何一项: (1) 已知的急性肝炎,包括活动性病毒性肝炎。 (2) 天冬氨酸转氨酶(AST)或丙氨酸转氨酶 (ALT)>5 倍正常上限(ULN)或总胆红素 >3 倍ULN。 (3) AST或 ALT>3 乘以 ULN,总胆红素>2 乘以ULN。 (4) 肝硬化病史。 (5) 终末期肝病的表现,例如腹水或肝性脑病。 (6) 中性粒细胞减少症。 (7) 血小板减少症; 14. 存在免疫缺陷或免疫功能低下者; 包括原发性免疫缺陷疾病,除局部皮肤癌或早期癌症以外的任何处于活跃期或近1年内确诊的恶性肿瘤,HIV感染,近1年内接受化疗/放疗/靶向治疗,实体器官移植,造血干细胞移植,近1月每天接受>=20mg强的松或等效剂量的糖皮质激素治疗>=14天,长期使用10mg/d强的松或等效剂量的糖皮质激素,近1月累积剂量>600mg的强的松,近1月接受生物免疫调节剂,近1月接受抗风湿药物或其他免疫抑制药物(如环孢素、环磷酰胺、羟氯喹、甲氨蝶呤等); 15. 处于妊娠期或哺乳期; 16. 正在参加其他临床试验; |
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Exclusion criteria: |
1. Known hypersensitivity to cephalosporins, macrolides, quinolones, or tetracyclines; 2. Administration of antibiotics for more than 24 hours within 7 days prior to admission; 3. Discharge from a medical institution within the past 60 days, or a history of more than 3 hospitalizations in the previous 3 years; 4. Blood oxygen saturation < 90% on admission; 5. Requirement for concurrent systemic antibacterial therapy that may be effective against CAP pathogens; 6. Suspected or confirmed viral, Legionella, Staphylococcus aureus, or Pseudomonas aeruginosa pneumonia; 7. Non-infectious causes of pulmonary infiltration (e.g., pulmonary embolism, chemical pneumonitis due to aspiration, hypersensitivity pneumonitis, congestive heart failure, bronchial obstruction, lung cancer, cystic fibrosis); 8. Confirmed or suspected empyema; 9. Diagnosis of chronic obstructive pulmonary disease or asthma; 10. Cerebrovascular disease (cerebral infarction, cerebral hemorrhage, cerebrovascular malformation); 11. Presence or risk of major cardiac events or cardiac dysfunction, including but not limited to: (1) Known prolonged QT interval or family history of long QT syndrome; (2) Untreated clinically significant hypokalemia before randomization; (3) Clinically unstable heart disease, including unstable atrial fibrillation, symptomatic bradycardia, unstable congestive heart failure, active myocardial ischemia, or permanent pacemaker implantation; (4) Complete left bundle branch block; 12. Severe renal impairment, defined as creatinine clearance (CrCl) <= 30 mL/min calculated by the Cockcroft–Gault formula; 13. Presence of high-risk factors affecting the prognosis of CAP treatment: (1) Hypoxemia; (2) Acidosis; (3) Hypotension (systolic blood pressure < 90 mmHg); (4) Pleural effusion; (5) Hypothermia (body temperature < 36 °C); (6) Multilobar involvement; (7) Radiographic cavitation; 14. Evidence of significant hepatic or hematological disease, including any of the following: (1) Known acute hepatitis, including active viral hepatitis; (2) Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) > 5 x upper limit of normal (ULN), or total bilirubin > 3 x ULN; (3) AST or ALT > 3 x ULN and total bilirubin > 2 x ULN; (4) History of liver cirrhosis; (5) Manifestations of end-stage liver disease (e.g., ascites, hepatic encephalopathy); (6) Neutropenia; (7) Thrombocytopenia; 15. Immunodeficiency or immunocompromised status, including: (1) Primary immunodeficiency disorders; (2) Active or newly diagnosed malignancy within the past 1 year (except localized skin cancer or early?stage cancer); (3) HIV infection; (4) Chemotherapy, radiotherapy, or targeted therapy within the past 1 year; (5) Solid organ transplantation or hematopoietic stem cell transplantation; (6) Treatment with >= 20 mg prednisone or equivalent daily for >= 14 consecutive days within the past month; (7) Long-term use of glucocorticoids at 10 mg/day prednisone or equivalent, with a cumulative dose > 600 mg prednisone within the past month; (8) Receipt of biological immunomodulators or anti-rheumatic/other immunosuppressive agents (e.g., cyclosporine, cyclophosphamide, hydroxychloroquine, methotrexate) within the past month; 16. Pregnancy or lactation; 17. Participation in another clinical trial; |
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研究实施时间: Study execute time: |
从 From 2025-01-01 00:00:00至 To 2027-12-31 00:00:00 |
征募观察对象时间: Recruiting time: |
从 From 2026-04-20 00:00:00 至 To 2027-04-20 00:00:00 |
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干预措施: Interventions: |
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研究实施地点: Countries of recruitment and research settings: |
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测量指标: Outcomes: |
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采集人体标本:
Collecting sample(s)
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征募研究对象情况: Recruiting status: |
尚未开始 Not yet recruiting |
年龄范围: Participant age: |
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性别: |
男女均可 |
Gender: |
Both |
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随机方法(请说明由何人用什么方法产生随机序列): |
由独立于本试验的生物统计师,在计算机上通过SAS 9.4统计软件采用分层区组随机分组方法、基于系统生成的随机种子数(由统计师盲选产生)和区组长度编制随机化程序,生成随机号和分组信息,产生随机的种子数以及随机结果作为盲底保存。预先生成516个连续编号(001-516)的随机分配序列,每个编号对应唯一的治疗分配(干预组或对照组,比例为1:1),并打印密封于信封之中,每个信封内包含该编号对应的分组信息。 |
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Randomization Procedure (please state who generates the random number sequence and by what method): |
A biostatistician independent of this trial used SAS 9.4 statistical software on a computer to develop a randomization program via the stratified block randomization method, based on a system-generated random seed (selected blindly by the biostatistician) and block length. This program generated random numbers and group assignment information, with the random seed and randomization results stored as the blind bottom (unblinded master randomization list). A random allocation sequence of 516 consecutive numbers (001–516) was generated in advance, with each number corresponding to a unique treatment assignment (intervention group or control group, in a 1:1 ratio). These sequences were printed, sealed in envelopes, and each envelope contained the group assignment information corresponding to the numbered sequence. |
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是否公开试验完成后的统计结果: Calculated Results after the Study Completed public access: |
不公开/Private |
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盲法: |
开放标签,对评估者隐藏分组 |
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Blinding: |
Open-label study with blinded-evaluators |
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是否共享原始数据: IPD sharing |
是Yes |
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共享原始数据的方式(说明:请填入公开原始数据日期和方式,如采用网络平台,需填该网络平台名称和网址): |
申请获取 |
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The way of sharing IPD”(include metadata and protocol, If use web-based public database, please provide the url): |
Upon request |
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数据采集和管理(说明:数据采集和管理由两部分组成,一为病例记录表(Case Record Form, CRF),二为电子采集和管理系统(Electronic Data Capture, EDC),如ResMan即为一种基于互联网的EDC: |
江苏省苏州市立医院采用CRF终版版本为基础,数据库管理人员采用Epidata软件进行数据采集系统构建。 |
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Data collection and Management (A standard data collection and management system include a CRF and an electronic data capture: |
The Suzhou Municipal Hospital of Jiangsu Province used the final version of the CRF as the foundation, and database managers constructed the data acquisition system using Epidata software. |
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数据与安全监察委员会: Data and Safety Monitoring Committee: |
有/Yes |