Gerbarg Z B, Horwitz R I
Department of Medicine, Yale University School of Medicine, New Haven, CT 06510.
J Clin Epidemiol. 1988;41(5):503-9. doi: 10.1016/0895-4356(88)90053-4.
Contradictory results among randomized clinical trials addressing similar questions are common and occur when the conclusions of different groups of investigators disagree, or when the results of several trials are statistically inconclusive. Meta-analysis, a term used to describe the process of evaluating and combining the results of conflicting studies, has been proposed as a method for reconciling the contradictory results. In this review of meta-analyses, we distinguish between the pooled and methodologic techniques, described the highly variable strategies used, and propose guidelines for improving the conduct of meta-analyses. In pooled analyses the results of multiple clinical trials are combined and the outcome is compared for patients receiving the principal and comparative therapy. In methodologic analyses the clinical trials are judged according to a set of standards used to assess scientific validity and clinical applicability. Since neither technique alone appeared satisfactory for resolving the conflicting results, we propose an approach to meta-analysis that requires methodologic criteria to identify scientifically valid studies, and pooling criteria to combine data from each of the studies. We believe this new strategy of meta-analysis will have enhanced scientific validity and clinical applicability.
针对相似问题的随机临床试验得出相互矛盾的结果是很常见的，当不同研究团队得出的结论不一致，或者多项试验结果在统计学上无定论时就会出现这种情况。荟萃分析是一个用于描述评估和合并相互冲突研究结果过程的术语，它已被提议作为调和矛盾结果的一种方法。在这篇关于荟萃分析的综述中，我们区分了汇总分析和方法学分析技术，描述了所使用的高度可变的策略，并提出了改进荟萃分析实施的指导原则。在汇总分析中，将多个临床试验的结果合并，并对接受主要治疗和对照治疗的患者的结果进行比较。在方法学分析中，根据一组用于评估科学有效性和临床适用性的标准对临床试验进行评判。由于单独使用这两种技术似乎都不足以解决相互冲突的结果，我们提出了一种荟萃分析方法，该方法需要方法学标准来识别科学有效的研究，并需要汇总标准来合并每项研究的数据。我们相信这种新的荟萃分析策略将提高科学有效性和临床适用性。
