基于倾向评分的中医药治疗高血压降低心脑血管风险的回顾性研究

发布时间：2018-12-07 16:45

【摘要】：目的:采用回顾性队列研究的方法评价中医药治疗高血压降低心脑血管风险的有效性。方法:采用回顾性队列研究,选取2001-2005年在我院全国中医高血压病治疗中心初诊并服用降压宝系列药物的病案数据库,用分层随机抽样的方法,最终筛选患者2500例作为样本人群,所有病人均符合相关标准。采用查阅病历和电话随访相结合的方式填写调查表,主要调查中药降压宝暴露程度即服用中药降压宝的时间、终点事件心脑血管事件发生情况。另外,调查影响高血压心脑血管风险的危险因素,包括患者个人资料、生活习惯、疾病情况、服药情况、血压总体控制情况以及心血管危险因素、靶器官损害、伴发临床疾患等。调查完成后形成分析数据库。其次,以暴露水平(中医累计治疗时间)分组,以心脑血管事件发生率和心脑血管病发病率等为主要评价指标,采取倾向评分法处理混杂因素,采用多元统计方法评价中药某一暴露水平的疗效,从而提取中医药治疗高血压降低心脑血管风险的有效率。结果:1.原始数据集:在PS匹配法调整前,A组未发生心脑血管事件的概率为82.68%,发生心脑血管事件的概率为17.31%,B组未发生心脑血管事件的概率为90.12%,发生心脑血管事件的概率为9.87%;在PS匹配法调整后,A组未发生心脑血管事件的概率为86.84%,发生心脑血管事件的概率13.15%,B组未发生心脑血管事件的概率为90.57%,发生心脑血管事件的概率9.42%,两组前后有效率差异小。2.组间比较结果:通过倾向评分法对数据进行调整后,整体均衡性得到改善,使得匹配后数据两组间更具可比性。两组心脑血管事件发生概率调整前后差异不大,说明原始资料均衡性较好。运用CMH检验对调整前后两组间心脑血管事件发生概率进行比较,调整前组间差别比较P=0.0002,具有统计学意义(P0.05);调整后组间差别比较P=0.0952,无统计学意义(P0.05)。结论:1、从本课题研究结果出发并不能证明降压宝系列中药对降低心脑血管风险的有效性,需要增加样本含量进一步统计分析研究调查;2、采用倾向评分法处理混杂因素的结果分析能够提高研究结论的真实性可靠性。
[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.
【学位授予单位】：河南中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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