【摘要】：目的:系統(tǒng)深入的評(píng)價(jià)目前常用的競(jìng)爭(zhēng)風(fēng)險(xiǎn)分析方法,探究競(jìng)爭(zhēng)事件對(duì)目標(biāo)結(jié)局事件發(fā)生風(fēng)險(xiǎn)的影響,比較不同分析方法之間的優(yōu)劣,提出競(jìng)爭(zhēng)風(fēng)險(xiǎn)分析的一般策略,為其在實(shí)際研究中的應(yīng)用提供理論依據(jù)。材料和方法:在林縣普通人群營養(yǎng)干預(yù)試驗(yàn)隨訪研究中,利用目前常用的競(jìng)爭(zhēng)風(fēng)險(xiǎn)分析方法深入全面的評(píng)價(jià)新鮮水果攝入與食管癌長期死亡風(fēng)險(xiǎn)之間的關(guān)聯(lián),探究競(jìng)爭(zhēng)事件在隨訪期間對(duì)食管癌長期死亡風(fēng)險(xiǎn)的影響,估計(jì)食管癌的基線死亡風(fēng)險(xiǎn),同時(shí)評(píng)價(jià)不同競(jìng)爭(zhēng)風(fēng)險(xiǎn)分析方法之間的優(yōu)劣,提出競(jìng)爭(zhēng)風(fēng)險(xiǎn)分析的一般策略。結(jié)果:1、當(dāng)存在競(jìng)爭(zhēng)風(fēng)險(xiǎn)偏倚時(shí),相對(duì)風(fēng)險(xiǎn)函數(shù)和相對(duì)風(fēng)險(xiǎn)比可以充分的評(píng)價(jià)競(jìng)爭(zhēng)事件對(duì)目標(biāo)結(jié)局事件發(fā)生風(fēng)險(xiǎn)的影響效應(yīng);虛擬觀測(cè)值法可以用于目標(biāo)結(jié)局事件基線發(fā)生風(fēng)險(xiǎn)的估計(jì);與原因別風(fēng)險(xiǎn)回歸分析的結(jié)果相比,使用累積風(fēng)險(xiǎn)回歸分析可以更準(zhǔn)確的估計(jì)所研究因素與目標(biāo)結(jié)局事件之間的關(guān)聯(lián)。2、在林縣普通人群營養(yǎng)干預(yù)試驗(yàn)隨訪隊(duì)列人群中,原因別風(fēng)險(xiǎn)回歸分析的結(jié)果顯示:與不攝入新鮮水果受試人群相比,每周攝入新鮮水果1次以上的受試者食管癌的長期死亡風(fēng)險(xiǎn)可能降低,且這種保護(hù)性的效應(yīng)并不隨著新鮮水果攝入頻率的增加而增加(P_Trend=0.444);累積風(fēng)險(xiǎn)回歸分析的結(jié)果則表明:新鮮水果的攝入可能不能降低食管癌的長期死亡風(fēng)險(xiǎn),提示競(jìng)爭(zhēng)風(fēng)險(xiǎn)偏倚的存在夸大了新鮮水果攝入與食管癌長期死亡風(fēng)險(xiǎn)之間的關(guān)聯(lián)。競(jìng)爭(zhēng)風(fēng)險(xiǎn)分析的結(jié)果顯示:競(jìng)爭(zhēng)事件對(duì)食管癌死亡風(fēng)險(xiǎn)的影響效應(yīng)隨著隨訪時(shí)間的延長而增大,尤其是心腦血管疾病的死亡,且在不同新鮮水果攝入頻率組中競(jìng)爭(zhēng)風(fēng)險(xiǎn)效應(yīng)的表現(xiàn)形式不同。進(jìn)一步分析發(fā)現(xiàn):在該隊(duì)列人群中食管癌的基線死亡風(fēng)險(xiǎn)為1.39,校正新鮮水果的攝入頻率后的食管癌基線死亡風(fēng)險(xiǎn)為1.62,提示新鮮水果的攝入肯能不能降低該隊(duì)列人群中食管癌的長期死亡風(fēng)險(xiǎn)。結(jié)論:1、在醫(yī)學(xué)隨訪研究中,推薦使用累積風(fēng)險(xiǎn)回歸分析來評(píng)價(jià)所研究因素與疾病之間的關(guān)聯(lián),同時(shí)使用相對(duì)風(fēng)險(xiǎn)函數(shù)和/或相對(duì)危險(xiǎn)比來描述競(jìng)爭(zhēng)事件對(duì)疾病發(fā)生風(fēng)險(xiǎn)的影響,提高研究結(jié)果的可解讀性。2、新鮮水果的攝入可能不能降低林縣營養(yǎng)干預(yù)試驗(yàn)隨訪隊(duì)列人群中食管癌的長期死亡風(fēng)險(xiǎn)。
[Abstract]:Objective: to evaluate the current commonly used methods of competitive risk analysis, to explore the impact of competition events on the risk of target outcome events, to compare the advantages and disadvantages of different analysis methods, and to put forward the general strategy of competitive risk analysis. It provides theoretical basis for its application in practical research. Materials and methods: in the follow-up study of nutrition intervention trial in the general population of Linxian County, the relationship between fresh fruit intake and long-term death risk of esophageal cancer was evaluated thoroughly by using the commonly used competitive risk analysis method. To explore the impact of competition events on the long-term mortality risk of esophageal cancer during the follow-up period, to estimate the baseline death risk of esophageal cancer, to evaluate the advantages and disadvantages of different competitive risk analysis methods, and to put forward the general strategy of competitive risk analysis. Results: 1, when there is a competitive risk bias, the relative risk function and the relative risk ratio can fully evaluate the effect of the competition event on the risk of the outcome event. The virtual observation method can be used to estimate the baseline risk of the target outcome event, and compared with the results of cause-specific risk regression analysis, The cumulative risk regression analysis was used to estimate the correlation between the factors studied and the target outcome events more accurately. The results of cause-specific risk regression analysis showed that subjects who ate fresh fruit more than once a week were more likely to have a lower long-term risk of death from esophageal cancer than those who did not eat fresh fruit. Moreover, the protective effect did not increase with the increase of fresh fruit intake (PIM trend 0.444), and the cumulative risk regression analysis showed that the intake of fresh fruit might not reduce the long-term mortality risk of esophageal cancer. These results suggest that the existence of competitive risk bias exaggerates the association between fresh fruit intake and long-term death risk of esophageal cancer. The results of competitive risk analysis showed that the effect of competition events on the death risk of esophageal cancer increased with the prolongation of follow-up time, especially the death of cardiovascular and cerebrovascular diseases. The expression of competitive risk effect was different in different fresh fruit intake frequency groups. Further analysis showed that the baseline mortality risk of esophageal cancer was 1.39 in this cohort and 1.62after adjusting for the intake frequency of fresh fruit, indicating whether the intake of fresh fruit can reduce the risk of death in this cohort. Risk of long-term death from esophageal cancer in the population. Conclusion: in the medical follow-up study, cumulative risk regression analysis was recommended to evaluate the association between the factors studied and the disease, and the relative risk function and / or relative risk ratio were used to describe the impact of competitive events on the risk of disease. Improving the decidibility of the study results. 2. The intake of fresh fruit may not reduce the long-term mortality risk of esophageal cancer in the follow-up cohort of nutrition intervention trials in Linxian County.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.1

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