Borzak S, Ridker P M
Cardiovascular Division, Henry Ford Hospital, Detroit, MI 48202, USA.
Ann Intern Med. 1995 Dec 1;123(11):873-7. doi: 10.7326/0003-4819-123-11-199512010-00010.
Clinicians making treatment decisions are faced with ever-growing numbers of therapies, each supported by different types of clinical data. By bringing together large amounts of data, meta-analysis has emerged as a useful tool for generating hypotheses with which to plan definitive trials, and it has also been recommended as a basis for decision making in the absence of definitive trials. In several instances, early meta-analyses have provided evidence of efficacy that was subsequently confirmed. However, in other instances, the results of initial meta-analyses have disagreed with the results of subsequent large-scale trials. Nitrate and magnesium therapy for acute myocardial infarction are two contemporary examples of treatments about which hypothesis-generating meta-analyses and subsequent large trials have disagreed. We review the issues surrounding the interpretation of meta-analyses in these cases, and we suggest that the appropriate use of meta-analyses in clinical decision making be carefully placed in the context of a review of pathophysiologic principles and the results of basic laboratory research and individual trials.
做出治疗决策的临床医生面临着越来越多的治疗方法，每种方法都有不同类型的临床数据支持。通过汇集大量数据，荟萃分析已成为生成用于规划确定性试验的假设的有用工具，并且在缺乏确定性试验的情况下，它也被推荐作为决策的基础。在一些情况下，早期的荟萃分析提供了随后得到证实的疗效证据。然而，在其他情况下，初始荟萃分析的结果与随后大规模试验的结果不一致。硝酸盐和镁治疗急性心肌梗死是关于生成假设的荟萃分析与随后大型试验结果不一致的两种当代治疗实例。我们回顾了这些情况下围绕荟萃分析解释的问题，并建议在对病理生理原则、基础实验室研究结果和个体试验进行回顾的背景下，谨慎地在临床决策中恰当使用荟萃分析。
