病例對(duì)照研究教案

授課教師

程靜

授課教授課對(duì)象2007級(jí)

教學(xué)日期名稱及版本第六版流行病 授課方式：講課程病例對(duì)照研究授間4（教學(xué)目（點(diǎn)案例教學(xué)：己烯雌酚與關(guān)系研究案例；經(jīng)典Doll和Hill吸煙與肺多匹配（matching）匹配過頭（overmatching）比值比（oddsratio）巢式病例對(duì)照研究（nestedcasecontrolstudy）病例隊(duì)列設(shè)計(jì)（case-cohortstudy）點(diǎn)Casecontrolstudyisalsocalled parisonstudy,Case-referentstudyandRetrospectivestudywhichstudytherelationshipbetweenexposureanddisease.Comparingwithcohortstudy,casecontrolstudyissavingontime,works,cheapandquickinobtainingtheresults.Thismethodissuitabletoexploreriskfactorofdisease,effectoftreatmentandsideeffectofmedicineandsoon..例與對(duì)照的對(duì)比，探討某因素與疾病之間可能存在因果關(guān)系的第一節(jié)基本原理basic，可比性的(對(duì)照)，他們發(fā)病前對(duì)某個(gè)（些）因素的情況，比較兩組中率和水平的差異，研究該疾病與這（）CasecontrolSubjectsareselectedonthebasisofwhethertheydo(cases)ordonot(controls)haveaparticulardiseaseunderstudy.Thegroupsarecomparedwithrespecttotheproportionhavingahistoryofanexposureorcharacteristicofinterest,tostudytherelationshipbetweentheseriskfactorsanddisease.CASEisindividualswithaneventorconditionofinterest,suchasdisease,health,effect,cure,death,sideeffectorsignorsyndromeofa（三對(duì)照”是未患該病或不具有所感的事件但具有可“CONTROLS”areindividualswithouttheeventorconditionofbasic（一）病例，確診患某種特定疾病的(cases,diagnosed“some 51515多演butcomparableto（三）通過詢問、檢查或復(fù)查病史，搜集既 因素（collectingexposurehistorybyrecall,labproportionin2groupsandstatisticaltesting）多演 eto ysistherelationshipbetweendiseaseandexposure）Doll和Hill吸煙與肺15※※第二節(jié)研究類型（classification）二、按病例、對(duì)照的來源分類（classificationinselectionofsubjects）三、按病例與對(duì)照匹配與否分類（classificationbasedonmatching）四、衍生的研究類型（derivedstudydesign）（一）巢式病例對(duì)照研究（nestedcasecontrol（二）病例隊(duì)列設(shè)計(jì)（case-cohort（三）單純病例研究（case-case（四）交叉研究（case-crossover（五）病例時(shí)間對(duì)照設(shè)計(jì)（casetimecontrol（example）VincentHerbst1515（一）Herbst對(duì)進(jìn)行探索（Herbststudiedtheriskfactorofvaginaadeicarcinoma）（二）7例患者加上另一個(gè)醫(yī)院１例患者作為病例組（7patientplusednotherdiagnosedinotherhospitalascases）（三）每個(gè)配4對(duì)照，共32個(gè)對(duì)照（Foreachcase,415多演were（四 員 （investigatorsurveyedcasesandtheirmother Only3riskfactorshowedsignificant（二）母親懷孕期間使用過己烯雌酚激素治療(P<0.00001)。Motherusedofstilbestrolduringpregnancy(P<0.00001). historyofabortionpreviously vaginableedinthispregnancy(P<0.05)做出結(jié)論：母親在妊娠早期服用己烯雌酚使她們?cè)谥械呐畠阂院蟀l(fā)生的性增加。（Conclusion:useofstilbestrolintheearlypregnancyofmotherincreasedtheriskoftheirdaughtereveninthe第四節(jié)研究設(shè)計(jì)與實(shí)施（designandimplement）二、病例與對(duì)照的選擇（selectionofcaseand exposurerateinstudypopulation（三）RR的近似值，OR值（查閱文獻(xiàn)或 （四）α（α※※第五節(jié)資料的整理與分析（datasortingand 一、均衡性檢驗(yàn)（heterogeneitytest） ysisf roupcomparing）三、1:1配對(duì)資料的分析（ ysisfor1:1matchingdata）四、混雜因素作用的估計(jì)與分層分析（estimationtheeffectofconfoundersandstratified 第六節(jié)常見偏倚及其控制（biasand control

1015 15二、對(duì)照選擇中的偏倚（biasinselectingcontrol）三、匹配研究方法的偏倚（biasinmatching）第七節(jié)實(shí)施病例對(duì)照研究應(yīng)注意的問題（attentionshouldpaytoimprovementstudy）（comparingthestrengthenandlimitofcaseandcontrolstudy）一、病例對(duì)照研究的優(yōu)點(diǎn)（strengthenofcasecontrolstudy）二、隊(duì)列研究的優(yōu)點(diǎn)（TheStrengthenofcohortstudy）（一）研究者親自觀察資料，信息可靠，回憶偏倚小（researchthemselvescollecteddata，valid information，fewerrecallbias）andRRandARdirectly）（三）（canconfirmthecausal（四）（conducetoknowthenaturalhistoryofdisease）onefactorwithmultiplediseases） 510（一）不適于研究比例很低的因素（notsuitabletostudylowerexposureratedisease） judgethe temporalrelationship，poorvalidofinformation）（四）（reca