Thompson S G
Medical Statistics Unit, London School of Hygiene and Tropical Medicine.
BMJ. 1994 Nov 19;309(6965):1351-5. doi: 10.1136/bmj.309.6965.1351.
Although meta-analysis is now well established as a method of reviewing evidence, an uncritical use of the technique can be very misleading. One common problem is the failure to investigate appropriately the sources of heterogeneity, in particular the clinical differences between the studies included. This paper distinguishes between the concepts of clinical and statistical heterogeneity and exemplifies the importance of investigating heterogeneity by using published meta-analyses of epidemiological studies of serum cholesterol concentration and clinical trials of its reduction. Although not without some dangers of speculative conclusions, prompted by overzealous inspection of the data to hand, a sensible investigation of sources of heterogeneity should increase both the scientific and the clinical relevance of the results of meta-analyses.
尽管荟萃分析作为一种证据审查方法现已得到广泛认可，但不加批判地使用该技术可能会产生很大的误导性。一个常见问题是未能适当地调查异质性的来源，尤其是所纳入研究之间的临床差异。本文区分了临床异质性和统计异质性的概念，并通过对血清胆固醇浓度流行病学研究和降低胆固醇临床试验的已发表荟萃分析，举例说明了调查异质性的重要性。尽管过度热心地检查手头数据可能会得出一些推测性结论，但对异质性来源进行合理调查应能提高荟萃分析结果在科学和临床方面的相关性。
