影响MDR-TB患者死亡的因素基于贝叶斯式考克斯回归模型
Zhiyong Wang1, Yuqi Zhang2, Wenlong Gao3
1Lanzhou Pulmonary Hospital, Lanzhou 730030. 1366620942@qq.com.
概括
耐多药结核病 (MDR-TB) 患者面临高死亡率,特别是在治疗的第一年内. 伴随性疾病增加死亡风险,而定期的随访和积极的初始唾液培养减少了死亡风险. 贝叶斯式考克斯模型为小样本大小提供了更可靠的分析.
科学领域:
- 流行病学 流行病学
- 医学统计 医学统计
- 传染性疾病 传染性疾病
背景情况:
- 耐多药结核病 (MDR-TB) 是一个重大的全球卫生挑战,死亡率高.
- 对MDR-TB患者的有效管理和治疗策略需要对影响不良结果的因素进行准确的分析.
- 传统的考克斯回归模型在处理小样本大小和其他生存分析中的实际问题方面存在局限性.
研究的目的:
- 分析在抗结核治疗期间对MDR-TB患者死亡的影响因素.
- 为了比较贝叶斯和常规考克斯回归模型的应用和可靠性,分析MDR-TB患者死亡率数据.
- 确定MDR-TB患者死亡率和保护因素的关键风险因素.
主要方法:
- 在2017年11月至2021年3月期间接受治疗的388名MDR-TB患者的数据上使用了生存分析.
- 传统和贝叶斯式考克斯回归模型用于估计危险比率 (HR) 和95%置信区间 (95% CI).
- 通过比较两个模型之间的参数标准偏差和95%CI范围来评估模型可靠性.
主要成果:
- 总体死亡率为3.1% (12例死亡),平均存活时间为10.18个月.
- 伴随性疾病显著增加了死亡风险 (HR=6.96常规,HR=7.80贝叶斯).
- 定期随访降低了死亡风险 (HR=0.19常规,HR=0.10贝叶斯),第一个阳性唾液培养与较低的风险相关 (HR=0.33贝叶斯).
- 贝叶斯考克斯模型表明参数标准偏差较小,CI范围较窄95%,表明参数估计更可靠,特别是对于小样本大小.
结论:
- 抗结核病治疗的第一年对MDR-TB患者的生存至关重要.
- 伴随性疾病是导致死亡的主要危险因素,而定期的随访和初始阳性唾液培养具有保护作用.
- 与传统的考克斯模型相比,贝叶斯式考克斯回归模型在MDR-TB研究中为小样本大小和低发病率结果提供了更高的参数估计可靠性.
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