【摘要】：目的:采用回顧性隊(duì)列研究的方法評(píng)價(jià)中醫(yī)藥治療高血壓降低心腦血管風(fēng)險(xiǎn)的有效性。方法:采用回顧性隊(duì)列研究,選取2001-2005年在我院全國(guó)中醫(yī)高血壓病治療中心初診并服用降壓寶系列藥物的病案數(shù)據(jù)庫(kù),用分層隨機(jī)抽樣的方法,最終篩選患者2500例作為樣本人群,所有病人均符合相關(guān)標(biāo)準(zhǔn)。采用查閱病歷和電話(huà)隨訪(fǎng)相結(jié)合的方式填寫(xiě)調(diào)查表,主要調(diào)查中藥降壓寶暴露程度即服用中藥降壓寶的時(shí)間、終點(diǎn)事件心腦血管事件發(fā)生情況。另外,調(diào)查影響高血壓心腦血管風(fēng)險(xiǎn)的危險(xiǎn)因素,包括患者個(gè)人資料、生活習(xí)慣、疾病情況、服藥情況、血壓總體控制情況以及心血管危險(xiǎn)因素、靶器官損害、伴發(fā)臨床疾患等。調(diào)查完成后形成分析數(shù)據(jù)庫(kù)。其次,以暴露水平(中醫(yī)累計(jì)治療時(shí)間)分組,以心腦血管事件發(fā)生率和心腦血管病發(fā)病率等為主要評(píng)價(jià)指標(biāo),采取傾向評(píng)分法處理混雜因素,采用多元統(tǒng)計(jì)方法評(píng)價(jià)中藥某一暴露水平的療效,從而提取中醫(yī)藥治療高血壓降低心腦血管風(fēng)險(xiǎn)的有效率。結(jié)果:1.原始數(shù)據(jù)集:在PS匹配法調(diào)整前,A組未發(fā)生心腦血管事件的概率為82.68%,發(fā)生心腦血管事件的概率為17.31%,B組未發(fā)生心腦血管事件的概率為90.12%,發(fā)生心腦血管事件的概率為9.87%;在PS匹配法調(diào)整后,A組未發(fā)生心腦血管事件的概率為86.84%,發(fā)生心腦血管事件的概率13.15%,B組未發(fā)生心腦血管事件的概率為90.57%,發(fā)生心腦血管事件的概率9.42%,兩組前后有效率差異小。2.組間比較結(jié)果:通過(guò)傾向評(píng)分法對(duì)數(shù)據(jù)進(jìn)行調(diào)整后,整體均衡性得到改善,使得匹配后數(shù)據(jù)兩組間更具可比性。兩組心腦血管事件發(fā)生概率調(diào)整前后差異不大,說(shuō)明原始資料均衡性較好。運(yùn)用CMH檢驗(yàn)對(duì)調(diào)整前后兩組間心腦血管事件發(fā)生概率進(jìn)行比較,調(diào)整前組間差別比較P=0.0002,具有統(tǒng)計(jì)學(xué)意義(P0.05);調(diào)整后組間差別比較P=0.0952,無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1、從本課題研究結(jié)果出發(fā)并不能證明降壓寶系列中藥對(duì)降低心腦血管風(fēng)險(xiǎn)的有效性,需要增加樣本含量進(jìn)一步統(tǒng)計(jì)分析研究調(diào)查;2、采用傾向評(píng)分法處理混雜因素的結(jié)果分析能夠提高研究結(jié)論的真實(shí)性可靠性。
[Abstract]:Objective: to evaluate the effectiveness of traditional Chinese medicine (TCM) in reducing cardiovascular and cerebrovascular risk in patients with hypertension by retrospective cohort study. Methods: a retrospective cohort study was used to select the database of medical records of patients who were first diagnosed and taken Jiangyabao series of drugs in our hospital from 2001 to 2005, and the method of stratified random sampling was used. Finally, 2500 patients were selected as sample population, all patients met the relevant criteria. The questionnaire was completed by means of consulting medical records and telephone follow-up to investigate the exposure degree of traditional Chinese medicine Jiangyapao that is to say the time of taking Chinese medicine Jiangya Bao and the occurrence of cardiovascular and cerebrovascular events at the end of the event. In addition, we investigated the risk factors affecting cardiovascular and cerebrovascular risk of hypertension, including patient's personal data, lifestyle, disease, medication, blood pressure control, cardiovascular risk factors, target organ damage, Accompanied by clinical diseases and so on. Upon completion of the investigation, an analytical database is formed. Secondly, the exposure level (TCM cumulative treatment time) was divided into groups, the incidence of cardiovascular and cerebrovascular events and the incidence of cardiovascular and cerebrovascular diseases were taken as the main evaluation indexes, and the mixed factors were dealt with by the tendency score method. Multivariate statistical method was used to evaluate the efficacy of traditional Chinese medicine (TCM) in the treatment of hypertension and the reduction of cardiovascular and cerebrovascular risk. Results: 1. The original data set: before the adjustment of PS matching method, the probability of no cardiovascular and cerebrovascular events in group A was 82.68 and the probability of occurrence of cardiovascular and cerebrovascular events in group B was 90.12. The probability of occurrence of cardiovascular and cerebrovascular events was 9.87; After the adjustment of PS matching method, the probability of no cardiovascular and cerebrovascular events in group A was 86.84, and the probability of no cardiovascular and cerebrovascular events in group B was 90.57. The probability of occurrence of cardiovascular and cerebrovascular events was 9.42, the difference between the two groups before and after the effective rate was small. 2. Results of comparison among groups: after adjusting the data by the tendency score method, the overall equilibrium is improved, which makes the data more comparable after matching between the two groups. There was no significant difference between the two groups before and after the adjustment of the occurrence probability of cardiovascular and cerebrovascular events, which indicated that the original data had a good balance. CMH test was used to compare the occurrence probability of cardiovascular and cerebrovascular events between the two groups before and after adjustment. The difference between the two groups before adjustment was 0.0002, which had statistical significance (P0.05). After adjustment, there was no significant difference between the two groups (P 0.05). Conclusion: 1. From the results of this study, it can not prove the effectiveness of Jiangya Bao series Chinese medicine in reducing cardiovascular and cerebrovascular risk, so it is necessary to increase the sample content to further statistical analysis and investigation. 2. The reliability of the conclusion can be improved by using the tendency score method to deal with the confounding factors.
【學(xué)位授予單位】：河南中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R259

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