导读:本文包含了预后变量论文开题报告文献综述及选题提纲参考文献，主要关键词:多结局生存分析,依时间变化协变量,胃癌,预后因素
预后变量论文文献综述
崔剑岚[1]（2014）在《应用多结局生存分析模型评价随时间变化的协变量对胃癌患者预后的影响》一文中研究指出背景：目前有关胃癌患者预后因素的分析都是以基线检测肿瘤生物标志物水平、炎症因子或白蛋白的基线因素测量值(进入研究时的观察变量取值)作为待筛选的变量,但绝大多数的肿瘤生物标志物都是反映了肿瘤状态,并且这些标志物往往与基线的肿瘤临床分期密切相关,许多肿瘤预后影响因素在不干预情况下会随着时间而发生变化的。如果某个因素在基线的暴露水平与肿瘤患者的预后有关联,并且该因素在随访的各个时间点的暴露水平有一定变化,则这个因素在随访的各个时间点的暴露水平也应该与肿瘤患者的预后有关联。如果这个暴露因素是可干预的,则我们往往需要知道这些可干预因素的暴露在随访过程中与患者预后的关联性。目的：本论文考察多结局生存分析模型在分析与时间变化有关的协变量的统计特征,利用多结局生存分析模型等方法评价与晚期胃癌病人预后相关的影响因素。同时,比较手术之后发生进展的晚期病人与本身晚期病人的生存情况及相关影响因素,包括用药情况与各项检测指标与PES、OS的关系,并评价疾病进展后的生存时间与进展前的时间之间的关系。方法和内容：根据现有样本资料,建立不同情况的模拟模型并产生模拟数据,依据模拟数据,评价包含依时间的协变量的多结局生存分析模型近期预测效果。利用包含依时间的协变量的多结局生存分析模型,研究从基线到各个化疗周期期间,全身性炎症因子(如CRP)、白蛋白、NLR、PLR以及各肿瘤标志物与晚期胃癌患者的PFS中位生存时间和OS中位生存时间的关联,将基线各指标与预后的关联性与使用多结局得到各次随访与预后的关联性进行比较。同时,使用一般Cox生存分析模型比较手术之后发生进展的晚期病人与本身晚期病人的生存情况及相关影响因素,包括用药情况与各项检测指标与PFS、OS的关系,并且通过重新定义时间区间评价疾病进展后的生存时间与进展前的时间之间的关系。此外,使用Pearson相关研究各次随访外周血T细胞亚群各个指标(如CD19+等)与各次随访的肿瘤标志物指标(如CEA, CA19-9等)的互相关性。主要结果和结论：多结局生存分析模型各次随访的各个参数估计的95%可信区间的覆盖率均在95%附近,95%可信区间的覆盖率基本不受样本量影响。在控制了年龄、性别等因素之后,C反应蛋白水平越高,疾病进展风险越大,在接受过根治性手术的病人中,HR=1.062 (95%CI:1.011,1.115),在未接受过根治性手术的病人中,HR=1.038 (95%CI:1.025,1.052)。而白蛋白水平越高,疾病进展风险越小,在接受过根治性手术的病人中,HR=0.908 (95%CI:0.825,0.998),在未接受过根治性手术的病人中,HR=0.948 (95%CI:0.914,0.982),PFS得到延长的患者,其在疾病进展之后的死亡风险小于PFS未延长的患者,且具有统计学意义。PFS每延长一个月,疾病进展后的总死亡风险就减少约11%,且疾病进展之前用药种类的不同对这种关联并不会产生较大的影响。对于PLR、NLR、AST、cyfra21-1、白蛋白、总蛋白这几个指标,无论用单结局的Cox模型还是多结局的生存分析模型,其HR均具有统计学显着意义,且HR值接近,因此,这些指标不仅在基线和胃癌患者的预后有联系,之后随访过程中的改变也与预后密切相关。同一变量每次随访的HR不同的多结局Cox生存分析模型结果显示,前期的肿瘤控制状况以及后期的全身恢复状况与胃癌患者的预后密切相关。(本文来源于《复旦大学》期刊2014-05-10）
陈海亮,赵兴文,刘迁,庄华章[2]（2012）在《结直肠癌预后相关因素配合时协变量的COX回归分析》一文中研究指出目的:研究结直肠癌的生存情况及影响因素,为临床预后的判断提供依据。方法:选择血清肿瘤标志物、肿瘤部位、DUCKS分期、等11项相关临床病生理指标,用SAS 9.2软件对598例结直肠癌患者进行单因素Kaplan-meier和多因素非比例风险的COX模型配合分析。结果:598例结直肠癌患者1年、3年、5年的生存率分别为91.79%、56.14%、21.89%,其中DUCK分期A期、B期、C期、D期患者5年生存率依次递减,分别为56.52%、29.81%、16.49%、8.98%;50%以上淋巴转移比50%以下淋巴转移患者5年生存率低约4%～5%,比无淋巴转移患者的5年生存率约低20%～21%。年龄为保护性影响因素,随着年龄的增加,结直肠癌患者的死亡风险减小0.0008倍。对上述各因素进行生存曲线比较(K-M法),差异均有统计学意义(均P<0.05)。结论:多因素分析结果显示,肿瘤的ducks分期、年龄、病理诊断、血清中癌胚抗原CEA的含量及糖链抗原是结肠癌生存预后的影响因素。(本文来源于《海南医学院学报》期刊2012年08期）
朱淳,边帆,吴萍[3]（2008）在《腹膜透析患者的死亡原因及多变量预后分析》一文中研究指出目的分析持续性不卧床式腹膜透析(CAPD)患者的死亡原因,探寻死亡预测因素。方法回顾性分析我院2000-03~2007-03收治的85例透龄3个月以上的CAPD患者,其中死亡组31例,存活组54例,记录患者的临床资料;采用多变量COX回归分析方法分析透析前各临床指标对预后的影响。结果死亡组31例患者中,死于严重感染8例(25.8%),心脑血管事件7例(22.6%),消化道出血5例(16.1%),营养不良3例(9.6%),其他原因8例(25.8%)。与存活组比较,死亡组年龄、血磷水平明显升高(P值均<0.01),而血红蛋白、血浆白蛋白和透析前肾小球滤过率明显降低(P值均<0.01),死亡组平均动脉压也较高(P<0.05);两组性别比、透析龄、尿素氮、血肌酐、尿酸、血钙等比较差异均无统计学意义。经COX回归分析提示,透析前患者年龄、肾小球滤过率和血磷水平为CAPD患者的死亡预测因素。结论多种因素影响CAPD患者的生存,而透析前年龄、肾小球滤过率和血磷水平则是预后的独立危险因素。(本文来源于《中国急救医学》期刊2008年05期）
陈丽萌,徐虹,周紫娟,李雪梅,崔莹[4]（2008）在《持续腹膜透析患者的生存率及多变量预后分析》一文中研究指出目的分析腹膜透析患者的生存率及其独立的预后因素,观察腹膜转运特性及相关临床特点对患者生存的影响。方法选择北京协和医院肾内科随诊腹膜透析患者232例,采用Cox模型回归分析透析开始时各临床指标对生存时间的影响。结果CAPD患者1年、2年、3年及4年总体生存率分别为91.1%、77.7%、68.7%及55.8%;单因素COX模型回归分析表明:糖尿病患者、腹膜高转运状态、年龄增加、血浆白蛋白低于3.0的患者预期生存率均降低(P<0.05)。232例患者中180(78%)位患者在开始透析的前6个月完成腹膜平衡实验(PET),其中高转运状态与死亡显着相关(与低于平均转运患者相比,RR2.70;95% CI 1.03 to 7.05;P=0.043)。经多因素COX模型回归分析,糖尿病和年龄是尿毒症腹膜透析患者死亡的独立危险因素。糖尿病患者死亡的相对危险度为非糖尿病患者的2.96倍(95% CI 1.62 to 5.38;P<0.0001);年龄每增加10岁,相对危险度增加0.31(P=0.039)。结论根据透析前年龄、原发病、血清白蛋白和腹膜的转运状态可以对腹膜透析患者的预后进行初步判断。(本文来源于《中国血液净化》期刊2008年03期）
Moscucci,M.,Rogers,E.K.,Montoye,C.,吴晓燕[5]（2006）在《持续性医疗质量改善计划与同期经皮冠状动脉介入医疗实践和预后变量的关系》一文中研究指出Background -The objective of this study was to evaluate the association of a continuous quality improvement program with practice and outcome variations of percutaneous coronary intervention(PCI). Methods and Results -Data on consecutive PCI were collected in a consortium of 5 hospitals; 3731 PCIs reflected care provided at baseline(January 1, 1998, to December 31, 1998), and 5901 PCIs reflected care provided after implementation of a continuous quality improvement intervention(January 1, 2002, to December 31, 2002). The intervention included feedback on outcomes, working group meetings, site visits, selection of quality indicators, and use of bedside tools for quality improvement and risk assessment. Postintervention data were compared with baseline and with 10 287 PCIs from 7 hospitals added to the consortium in 2002. Quality indicators included use of preprocedural aspirin or clopidogrel, use of glycoprotein IIb/IIIa receptor blockers and postprocedural heparin, and amount of contrast media per case. Outcomes selected included emergency CABG, contrast nephropathy, myocardial infarction, stroke, transfusion, and in-hospital death. Compared with baseline and the control group, the intervention group at follow-up had higher use of preprocedural aspirin and glycoprotein IIb/IIIa blockers, lower use of postprocedural heparin, and a lower amount of contrast media per case(P< 0.05). These changes were associated with lower rates of transfusions, vascular complications, contrast nephropathy, stroke, transient ischemic attack, and combined end points(all P< 0.05). Conclusions -Our nonrandomized, observational data suggest that implementation of a regional continuous quality improvement program appears to be associated with enhanced adherence to quality indicators and improved outcomes of PCI. A randomized clinical trial is needed to determine whether this is a “causal”or a “casual”relationship.(本文来源于《世界核心医学期刊文摘(心脏病学分册)》期刊2006年10期）
Poulter,N.,R.,Wedel,H.,Dahlf,B.,孙凯[6]（2006）在《血压和其他变量对不同心血管事件发生率的作用:英国-斯堪的纳维亚心脏预后试验-降压部分(ASCOT-BPLA)》一文中研究指出Background: Results of the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm(ASCOT-BPLA) show significantly lower rates of coronary and stroke events in individuals allocated an amlodipine-based combination drug regimen than in those allocated an atenolol-based combination drug regimen(HR 0.86 and 0.77, respectively). Our aim was to assess to what extent these differences were due to significant differences in blood pressures and in other variables noted after randomisation. Methods: We used data from ASCOT-BPLA(n=19 257) and compared differences in accumulated mean blood pressure levels at sequential times in the trial with sequential differences in coronary and stroke events. Serial mean matching for differences in systolic blood pressure was used to adjust HRs for differences in these events. We used an updated Cox-regression model to assess the effects of differences in accumulated mean levels of various measures of blood pressure, serum HDL cholesterol, triglycerides and potassium, fasting blood glucose, heart rate, and bodyweight on differences in event rates. Findings: We noted no temporal link between size of differences in blood pressure and different event rates. Serial mean matching for differences in systolic blood-pressure attenuated HRs for coronary and stroke events to a similar extent as did adjustments for systolic blood-pressure differences in Cox-regression analyses. HRs for coronary events and stroke adjusted for blood pressure rose from 0.86(0.77-0.96) to 0.88(0.79-0.98) and from 0.77(0.66-0.89) to 0.83(0.72-0.96), respectively. Multivariate adjustment gave HRs of 0.94(0.81-1.08) for coronary events(HDL cholesterol being the largest contributor) and 0.87(0.73-1.05) for stroke events. Interpretation: Multivariate adjustment accounted for about half of the differences in coronary events and for about 40% of the differences in stroke events between the treatment regimens tested in ASCOT-BPLA, but residual differences were no longer significant. These residual differences could indicate inadequate statistical adjustment, but it remains possible that differential effects of the two treatment regimens on other variables also contributed to the different rates noted, particularly for stroke.(本文来源于《世界核心医学期刊文摘(心脏病学分册)》期刊2006年02期）
Saugstad,O.D.,Ramji,S,Rootwelt,T.,Vento,M.,张振[7]（2006）在《新生儿复苏术的疗效研究:早期预后性变量》一文中研究指出Aim: To characterize the development of clinically relevant variables the firs t minutes after birth and identify early prognostic markers in newborn infants r equiring resuscitation. Methods: A database of 591 infants resuscitated with eit her 21%or 100%oxygen was analysed. Time to first breath, development in heart rate, Apgar scores, arterial oxygen saturation (SaO2), and base deficit (BD) are described in relation to different degrees of birth depression and outcomes. Re sults: Heart rate and Apgar scores increased quickly even in the most depressed infants but were significantly lower in those having a poor outcome. By contrast , BD normalized at the same rate, 6-7 mmol/l/h, in the first hour of life regar dless of the degree of birth depression and outcome. SaO2 values increased as qu ickly in room air as in 100%-oxygen-resuscitated infants. Time to first breat h was prolonged threefold, from 1 to 3 min, in the most depressed (1-min Apgar score < 4) compared with the less depressed infants. Highest odds ratio (OR) for death in the first week of life or for development of hypoxic-ischaemic enceph alopathy (HIE) stage 2 and 3 was a 5-min heart rate ≤60 bpm (OR 16.5 for both death and HIE) and Apgar <4 (OR 14 and 18.8). Neonatal survival for HIE stage 1, 2, and 3 was 93%, 63%, and 11%, respectively. OR for early neonatal death, i f SaO2 ≤60%at 1 min, was 8.6 (sensitivity 0.82 and specificity 0.65). Conclusi on: Apgar scores, heart rate, SaO2, and time to first breath in newly born infan ts in need of resuscitation may be used for early identification of infants with a poor prognosis. These data may be helpful in describing the severity of depre ssion in single infants and to select infants in need of interventional therapy.(本文来源于《世界核心医学期刊文摘(儿科学分册)》期刊2006年01期）
Figueras,J.,Domingo,E.,Hermosilla,E.,郝广华[8]（2005）在《首次发生不稳定型心绞痛患者的临床变量、冠状动脉储备及冠状动脉病变范围的远期预后》一文中研究指出Clinical and ECG prognostic markers, ischemic threshold(IT)-and extent of coronary disease were analyzed in 383 patients with unstable angina(UA) and correlated with long-term events. Patients >74 years or those with severe heart failure or previous revascularization procedures were excluded. There were 369 events in 245 patients: 87 deaths, 96 myocardial infarction(MI), 111 coronary artery bypass grafting(CABG), and 75 angioplasty procedures(PTCA). Follow-up was obtained in 367 hospital survivors(99%, 114(44) months) and ST depression on admission ECG, a modest enzyme rise, refractory angina( >2 episodes), two to three vessel coronary disease and a reduced IT(≤130 beats/min) were each associated with cardiac events. A multivariate analysis, however, showed refractory angina(p< 0.001) and multivessel disease(p< 0.001) as most significant predictors. After their exclusion, IT was most relevant predictor(p< 0.001). However, the predictive value of these markers was essentially centered on first-year events(249, 67%). Moreover, refractory angina, minor enzyme rise and admission ST depression were each highly correlated with a reduced IT(p< 0.006) and with multivessel disease(p< 0.0001). Therefore, these findings underscore that the prognostic value of conventional clinical markers in patients with UA is limited to first-year events and that their remarkable correlation with extensive coronary disease and reduced coronary reserve reveal the anatomical substrate of this prognostic significance.(本文来源于《世界核心医学期刊文摘(心脏病学分册)》期刊2005年07期）
Miki,C,,Konishi,N,,Ojima,E[9]（2005）在《C反应蛋白可作为一种反映结直肠癌IL-1-IL-6网络系统自由上调的预后变量指标》一文中研究指出Up-regulation of the IL-1-IL-6 network stimulates systemic expression of C-reactive protein (CRP). This cytokine network system plays a pivotal role in inducing angiogenic growth factors in intestinal mucosa. Serum CRP level and tissue concentrations of cytokines in colorectal cancer patients were determined and an in vitro model was employed to determine the time course of induction of IL-6 in Caco-2 cells. Increased serum CRP was associated with recurrent disease and shorter survival time. Intense surgical stress and the presence of an acute phase reactant were independently associated with overexpression of IL-6 in the tumor. Enhanced IL-6 protein expression in Caco-2 cells induced by the initial treatment with IL-1β or lipopolysaccharide could be abrogated by additional presupplementation of IL-1ra. The presence of an acute phase reactant reflects uncontrolled up-regulation of the local IL-1-IL-6 network system in the tumor, which may enhance the survival and proliferation of remnant cancer cells after tumor resection.(本文来源于《世界核心医学期刊文摘(胃肠病学分册)》期刊2005年01期）
李国平,游潮,黄思庆,甘全洲,易章超[10]（2004）在《脑电图二分法变量评分对重型颅脑损伤预后的临床研究》一文中研究指出目的 :分析总结脑电图二分法变量评分对重型颅脑损伤预后判断的临床意义。方法 :对 70例颅脑损伤病人进行EEG检查 ,并采用Grant氏二分法变量评分对其预后进行预测和评估。结果 :预测准确率是 :重型组为 86 4 % ,中型组为 87 5 % ,轻型组为 10 0 % ;而GCS评估的分别为 5 9 1% ,83 3% ,10 0 %。在重型组中EEG分法变量评分预测其预后的准确率明显高于GCS评分 (P <0 0 5 ) ,在中、轻型组中二者预测预后的准确率无显着性差异 (P >0 0 5 )。结论 :对重型颅脑损伤EEG二分法变量评分评估预后优于GCS评分 ,EEG二分法变量评分为一种良好的评估预后的客观指标。(本文来源于《华西医学》期刊2004年02期）
预后变量论文开题报告
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目的:研究结直肠癌的生存情况及影响因素,为临床预后的判断提供依据。方法:选择血清肿瘤标志物、肿瘤部位、DUCKS分期、等11项相关临床病生理指标,用SAS 9.2软件对598例结直肠癌患者进行单因素Kaplan-meier和多因素非比例风险的COX模型配合分析。结果:598例结直肠癌患者1年、3年、5年的生存率分别为91.79%、56.14%、21.89%,其中DUCK分期A期、B期、C期、D期患者5年生存率依次递减,分别为56.52%、29.81%、16.49%、8.98%;50%以上淋巴转移比50%以下淋巴转移患者5年生存率低约4%～5%,比无淋巴转移患者的5年生存率约低20%～21%。年龄为保护性影响因素,随着年龄的增加,结直肠癌患者的死亡风险减小0.0008倍。对上述各因素进行生存曲线比较(K-M法),差异均有统计学意义(均P<0.05)。结论:多因素分析结果显示,肿瘤的ducks分期、年龄、病理诊断、血清中癌胚抗原CEA的含量及糖链抗原是结肠癌生存预后的影响因素。
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预后变量论文参考文献
[1].崔剑岚.应用多结局生存分析模型评价随时间变化的协变量对胃癌患者预后的影响[D].复旦大学.2014
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