Bertolini Guido, Luciani Davide, Biolo Gianni
Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva Coordinating Center-Laboratory of Clinical Epidemiology, Mario Negri Institute for Pharmacological Research, Aldo e Cele Daccò, Ranica (Bergamo), Italy.
Clin Nutr. 2007 Feb;26(1):25-9. doi: 10.1016/j.clnu.2006.08.005. Epub 2006 Oct 16.
BACKGROUND & AIMS: Two different ways of thinking pervaded the history of science: rationalism and empiricism. In theory, these two paradigms are not necessarily in conflict. In practice, there has always been tension between them. The coming of evidence-based medicine put empiricism in a privileged position, but empiricism without a rationalistic guide could even be usefulness. The aim of this work is to present the tension between the rational reasons to administer immunonutrients to patients with sepsis and the controversial empirical evidence stemming from clinical trials.
We reviewed the literature on immunonutrition in sepsis from the rationalist and the empiricist perspectives.
The large body of evidence for positive effects of immunonutrients in experimental models and the contradictory results from clinical trials make the discussion on immunonutrition in sepsis a typical example where the conflict between rationalism and empiricism hampered the advancement of knowledge and the implementation of new effective therapies into clinical practice.
Future research projects involving immunonutrients should be based on robust knowledge of basic mechanisms of action to be properly addressed in clinical trials.
科学史上存在两种不同的思维方式：理性主义和经验主义。理论上，这两种范式不一定相互冲突。但在实践中，它们之间一直存在紧张关系。循证医学的出现使经验主义占据了优势地位，但没有理性主义指导的经验主义甚至可能毫无用处。这项工作的目的是呈现给脓毒症患者使用免疫营养剂的理性依据与来自临床试验的有争议的经验证据之间的紧张关系。
我们从理性主义和经验主义的角度回顾了关于脓毒症免疫营养的文献。
免疫营养剂在实验模型中产生积极作用的大量证据以及临床试验的矛盾结果，使得关于脓毒症免疫营养的讨论成为一个典型例子，即理性主义和经验主义之间的冲突阻碍了知识的进步以及新的有效疗法在临床实践中的应用。
未来涉及免疫营养剂的研究项目应基于对基本作用机制的充分了解，以便在临床试验中得到妥善处理。
