Acetylcysteine in the prevention of contrast-induced nephropathy - A case study of the pitfalls in the evolution of evidence
Acetylcysteine in the prevention of contrast-induced nephropathy - A case study of the pitfalls in the evolution of evidence
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DOI：
10.1001/archinte.166.2.161
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发表时间：
2006-01-23
影响因子：
--
通讯作者：
Ghali, WA
中科院分区：
文献类型：
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作者：
Bagshaw, SM;McAlister, FA;Ghali, WA
在过去的5年中，已发表了19项随机对照试验、4项前瞻性非随机研究和11项荟萃分析，探讨了乙酰半胱氨酸在预防造影剂肾病中的作用。在此，我们总结了这些文献，并证明这34项实证研究尚未最终解决这一研究问题。我们使用关于乙酰半胱氨酸的证据作为研究证据如何积累的案例研究，并考虑是否可以采用另一种方法来研究乙酰半胱氨酸的有效性问题，从而得出更明确的结论。我们考虑了从这个乙酰半胱氨酸案例研究中吸取的更广泛的教训，并提出了可以采取的具体步骤，以改善未来研究活动的协调，最终在重要的临床问题上产生更有意义和明确的证据。
During the past 5 years, 19 randomized controlled trials, 4 prospective nonrandomized studies, and 11 meta-analyses that explored the role of acetylcysteine for prevention of contrast-induced nephropathy have been published. Herein, we summarize this literature and demonstrate that these 34 empirical studies have not yet conclusively resolved this research question. We use the evidence on acetylcysteine as a case study of how research evidence accumulates and consider whether an alternative approach to investigating the question of acetylcysteine's efficacy could have resulted in a more definitive conclusion. We consider the broader lessons learned from this acetylcysteine case study for the medical and research communities and propose specific steps that could be taken to,improve the future coordination of research activity to ultimately yield more meaningful and definitive evidence on important clinical questions.