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目的 探索内镜介入治疗疼痛性慢性胰腺炎(CP)无效的风险因素。方法分析随访1997年至2006年仅经内镜治疗且存活的疼痛性慢性胰腺炎资料,根据患者临床特征及相关研究资料选择与治疗无效可能相关的风险因素,利用Cox比例风险模型进行逐步回归分析。结果患者中男114例、女58例,平均39.4岁,148例(86.0%)内镜治疗有效。多因素Cox比例风险模型逐步回归显示,首发年龄(〉36岁)、治疗前轻中度腹痛、内镜治疗后酒精摄入量无明显减少和饮食不节为内镜治疗无效的预后因素,风险比分别为3.5、2.4、1.9和2.8。结论疼痛性慢性胰腺炎内镜介入治疗后应戒酒和低脂规律饮食,首发年龄大、腹痛程度相对较轻的患者尤其应当注意。 相似文献
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目的探讨不完全病例对照研究中对照组基因信息部分缺失时基因一环境交互作用的估计。方法在Stata9.0软件上采用MonteCarlo方法模拟不同基因信息缺失比例数据,对缺失数据采用hotdeck多重填补程序后分析和删除缺失值分析结果进行比较。结果缺失数据〈50%时,hotdeck多重填补后分析和删除缺失值分析对环境主效应、基因主效应以及基因-环境交互作用的估计系数接近完全数据的系数,随缺失比例的增加,两种方法的估计方差均增加,但hotdeck多重填补估计方差小于删除缺失值分析。结论不完全病例对照研究中,对照组基因信息缺失比例〈50%时,可以用hotdeck填补方法充分利用已有的信息估计基因-环境的交互作用,提高估计精度。 相似文献
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Objective To investigate the incidence of diabetes mellitus and risk factors for the disease in chronic pancreatitis (CP) patients.Methods A historical cohort study on subjects with painful CP who were admitted to hospital from Jan.1997 to July 2007 were conducted.A life-table method was used to estimate the cumulative probability of the development of diabetes mellitus once clinical onset of abdominal pain.Cox proportional-hazards model was used for multivariate analysis of the variables including age,sex,drinking and smoking habits,etiological factor,presence of pancreatic masses,pancreatic calcifications,measure of intervention,diarrhea,weight loss and degree of pain.Results Data were obtained from 354 patients (239 males,mean age at onset of pain (38.1±17.6) years;alcoholic origin 18.1%) with painful CP.The mean follow-up period was (45.2±32.9)months.The rate of diabetes mellitus in CP patients was 16.1%.There was a high incidence (29.8%)of diabetes mellitus 1 year before the episodes of abdominal pain.The cumulative risk of diabetes mellitus in subjects 5 and 10 years after the episodes of pain was 9.3% and 20.7%,respectively.Cox proportional-hazards model selected smoking (>10 pack years) (hazard rate (HR)= 3.3),mild abdominal pain (HR=5.2),weight loss (HR = 2.6) and pancreatic calcifications (HR = 2.2) as variables identifying subjects with diabetes mellitus in patients with painful CP before they were performed therapeutic endoscopy or surgical intervention.Smoking (>10 pack years) (HR = 3.0),weight loss (HR= 2.8) and distal pancreatectomy (HR =7.3) were identified with an increased risk of diabetes mellitus in these cases after they received therapeutic endoscopy or surgical intervention.Conclusion The risk factors of diabetes mellitus for CP appears to be independent of smoking (>10 pack years),mild abdominal pain,weight loss,pancreatic calcifications and distal pancreatectomy. 相似文献
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目的探讨Bayesian两变量层次模型的构建及其在诊断试验系统评价中的应用。方法将Bayesian两变量层次模型应用于传统Pap细胞学涂片诊断子宫颈癌准确性评价的历史Meta分析资料,估计相关的效应指标敏感度和特异度及筛查研究比随访研究的相对可信度。结果与经典综合受试者工作特征曲线方法相比,Bayesian两变量层次模型估计得到三个层次的效应指标,其中综合敏感度和特异度均数及95%可信区间分别为0.64(0.56,0.72)和0.74(0.67,0.80),预测敏感度和特异度均数及95%可信区间分别为0.61(0.12,0.96)和0.69(0.21,0.97),筛查研究比随访研究的相对可信度估计为1.3(0.59,2.48)。结论采用Bayesian两变量层次模型进行诊断试验Meta分析,更加灵活、有效,易于实现和解释,值得推广应用。 相似文献
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目的 系统评价可吸入颗粒物(PM10)对心血管系统急性有害效应的影响.方法 检索PubMed、CBM、CNKI 等数据库,同时手工检索相关杂志和参考文献,选择符合标准的文献,进行meta分析. 结果截至2008年8月,共纳入21 篇文献,其中11 篇文献是时间序列研究,10 篇文献是病例交叉研究.meta 分析提示可吸入颗粒物(PM10)与心血管疾病发作有关(OR=1.008,95%CI=1.006~1.011,P=0.000),同时会增加心血管疾病的死亡风险(OR=1.006,95%CI=1.004~1.009,P=0.000).结论 PM10 短期暴露与人群心血管疾病发作、死亡风险存在关联. 相似文献
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目的 探讨meta分析预测(meta analytic predictive, MAP)法在二分类终点临床试验中借用历史对照组数据的信息。方法 通过模拟试验评价历史试验数据的异质性及先验数据冲突对于研究的Ⅰ类错误及检验效能的影响,并对Secukinumab治疗强直性脊柱炎的实际案例进行分析。结果 当先验数据冲突不存在时,MAP方法能较好地控制Ⅰ类错误并提高检验效能。随着历史试验间异质性增加,Ⅰ类错误会略有膨胀而检验效能略有降低。当先验数据冲突时,会造成Ⅰ类错误膨胀,若历史试验利于试验组优于对照组的结论时检验效能会增加,反之检验效能会降低。Secukinumab治疗强直性脊柱炎的案例显示,MAP方法能够在新试验对照组样本量较少的情况下,借用历史试验信息,可以识别出试验药与对照药的差异。结论 本文对临床试验中信息借用的MAP方法提供了方法学和案例研究支持,评估了先验数据冲突及异质性对信息借用的影响,具有较强的实用价值。 相似文献
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Objective To investigate the incidence of diabetes mellitus and risk factors for the disease in chronic pancreatitis (CP) patients.Methods A historical cohort study on subjects with painful CP who were admitted to hospital from Jan.1997 to July 2007 were conducted.A life-table method was used to estimate the cumulative probability of the development of diabetes mellitus once clinical onset of abdominal pain.Cox proportional-hazards model was used for multivariate analysis of the variables including age,sex,drinking and smoking habits,etiological factor,presence of pancreatic masses,pancreatic calcifications,measure of intervention,diarrhea,weight loss and degree of pain.Results Data were obtained from 354 patients (239 males,mean age at onset of pain (38.1±17.6) years;alcoholic origin 18.1%) with painful CP.The mean follow-up period was (45.2±32.9)months.The rate of diabetes mellitus in CP patients was 16.1%.There was a high incidence (29.8%)of diabetes mellitus 1 year before the episodes of abdominal pain.The cumulative risk of diabetes mellitus in subjects 5 and 10 years after the episodes of pain was 9.3% and 20.7%,respectively.Cox proportional-hazards model selected smoking (>10 pack years) (hazard rate (HR)= 3.3),mild abdominal pain (HR=5.2),weight loss (HR = 2.6) and pancreatic calcifications (HR = 2.2) as variables identifying subjects with diabetes mellitus in patients with painful CP before they were performed therapeutic endoscopy or surgical intervention.Smoking (>10 pack years) (HR = 3.0),weight loss (HR= 2.8) and distal pancreatectomy (HR =7.3) were identified with an increased risk of diabetes mellitus in these cases after they received therapeutic endoscopy or surgical intervention.Conclusion The risk factors of diabetes mellitus for CP appears to be independent of smoking (>10 pack years),mild abdominal pain,weight loss,pancreatic calcifications and distal pancreatectomy. 相似文献