biostatistics

生物统计学
  • 文章类型: Journal Article
    医学科学必须基于可靠和科学的证据,并需要持续的研究。从事研究可以让学生和教师探索新的领域,质疑现有的范式,并发现医疗挑战的创新解决方案。作为特产,社区医学在解决公共卫生问题方面发挥着关键作用。然而,社区医学居民在生物医学研究中的参与度仍然欠佳,这可能会阻碍针对印度背景的循证实践的产生。这项研究是为了寻找社区医学居民的兴趣和参与度,以及影响他们对生物医学研究兴趣的因素。方法对北方邦社区医疗居民进行在线调查,从2024年2月到4月,使用具有半结构化的GoogleForms,预先测试的问卷。结果一百九十六名居民参与研究,其中女性(52.6%;103/196)超过男性(47.4%;93/196)。大多数参与者是三年级居民(40.8%)。大多数参与者似乎对生物医学研究感兴趣(83.2%),并认为生物医学研究基础课程(BCBR)有助于开展研究项目(75%)。大约一半的人以前有研究项目的经验,横断面研究是最常见的(75.9%)研究设计。提高研究技能和为医学知识做出贡献的愿望成为主要动力。另一方面,由于学术和教育活动负担过重而缺乏时间被视为进行研究的最常见障碍。结论发现大多数参与者对研究活动感兴趣。提高研究技能的机会,渴望为医疗兄弟会服务,对简历的积极影响是进行研究的主要激励因素。难以节省时间,小知识,导师的不良支持被认为是重要的障碍。
    Introduction Medical science must be based on sound and scientific evidence and requires continuous research. Engaging in research allows students and faculty to explore new frontiers, question existing paradigms, and discover innovative solutions to medical challenges. As a specialty, community medicine plays a pivotal role in addressing public health issues. However, the engagement of community medicine residents in biomedical research remains suboptimal, which may impede the generation of evidence-based practices tailored to the Indian context. This study was conducted to find the interest and engagement of community medicine residents, and factors influencing their interest in biomedical research. Methods An online survey was conducted among community medicine residents of Uttar Pradesh, from February to April 2024, using Google Forms having a semi-structured, pretested questionnaire. Results One hundred and ninety-six residents participated in the study, where females (52.6%; 103/196) outnumbered males (47.4%; 93/196). The majority of participants were third-year residents (40.8%). Most participants seemed interested in biomedical research (83.2%) and thought that Basic Course in Biomedical Research (BCBR) helps conduct research projects (75%). Around half had previous experience in research projects, with cross-sectional studies being the most common (75.9%) study design. Enhancing research skills and a desire to contribute to medical knowledge emerged as primary motivators. On the other hand, the lack of time due to being overburdened with academic and educational activities was seen as the most common barrier to conducting research. Conclusions The majority of participants were found interested in research activities. The opportunity to improve research skills, desire to serve the medical fraternity, and a positive impact on resumes were the leading motivating factors for conducting research. Difficulty in sparing time, little knowledge, and poor support from mentors were found as important barriers.
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  • 文章类型: Journal Article
    结论:计算信号去卷积的最新方法进展使得能够在更精细的细胞类型水平上进行大量转录组数据分析。通过反卷积,鉴定细胞类型特异性差异表达(csDE)基因在临床应用中引起越来越多的关注。然而,研究人员在实践中采用CSDE检测方法仍然面临许多困难,尤其是在他们的实验设计中.这里我们介绍柏树,首次实验设计和统计学分析工具在CSDE鉴定中的应用。该工具可以可靠地模拟纯化的细胞类型特异性(CTS)配置文件,细胞类型成分,生物和技术的变化,为批量RNA-seq卷积和反卷积提供高保真模拟器。赛柏树进行模拟,评估多个影响因素的影响,通过各种生物统计指标,帮助研究人员优化实验设计和进行功率分析。
    方法:cypress是位于https://bioparductor.org/packages/cypress/的开源R/Bioconductor软件包。
    背景:补充数据可在Bioinformatics在线获得。
    CONCLUSIONS: Recent methodology advances in computational signal deconvolution have enabled bulk transcriptome data analysis at a finer cell-type level. Through deconvolution, identifying cell-type-specific differentially expressed (csDE) genes is drawing increasing attention in clinical applications. However, researchers still face a number of difficulties in adopting csDE detection methods in practice, especially in their experimental design. Here we present cypress, the first experimental design and statistical power analysis tool in csDE identification. This tool can reliably model purified cell-type-specific (CTS) profiles, cell-type compositions, biological and technical variations, offering a high-fidelity simulator for bulk RNA-seq convolution and deconvolution. cypress conducts simulation and evaluates the impact of multiple influencing factors, by various biostatistical metrics, to help researchers optimize experimental design and conduct power analysis.
    METHODS: cypress is an open-source R/Bioconductor package at https://bioconductor.org/packages/cypress/.
    BACKGROUND: Supplementary data are available at Bioinformatics online.
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  • 文章类型: Journal Article
    已经报道了口腔健康的心理社会特性。本研究旨在通过使用固定效应分析来控制混杂因素,调查自然牙齿完全丧失对孤独感的因果影响。包括未测量的时不变因子。来自参与至少2个连续的英国纵向老龄化研究第3波(2006/2007)的老年人的数据,5(2010/2011),和7(2014/2015)进行了分析(N=7,682观察值,来自7,298名个体)。使用固定效应线性回归分析调整时变混杂因素,检查了天然牙齿完全丧失与孤独感评分(3至9)之间的关联。包括社会人口统计学和健康特征。牙齿完全脱落的患病率为12.7%,12.8%,波3、5和7分别为10.6%。在任何2次连续波期间过渡到完全牙齿缺失的个体的孤独感得分增加了0.27(95%置信区间[CI]0.03,0.52),高于那些保持自然牙齿的人(-0.03;95%CI-0.05,-0.01)。调整时变混杂因素的固定效应分析显示,天然牙齿完全丧失与孤独感得分增加0.31之间存在显着关联(95%CI0.17,0.46)。英格兰老年人中天然牙齿的完全丧失与孤独有关,即使在考虑了测量的时变和(未)测量的时不变混杂因素之后。保留天然牙齿可以减少孤独的风险。
    Psychosocial properties of oral health have been reported. The present study aimed to investigate the causal effect of complete loss of natural teeth on loneliness by using fixed-effects analysis to control for confounding factors, including unmeasured time-invariant factors. Data from older adults participating in at least 2 consecutive waves of the English Longitudinal Study of Ageing in waves 3 (2006/2007), 5 (2010/2011), and 7 (2014/2015) were analyzed (N = 18,682 observations from 7,298 individuals). The association between complete loss of natural teeth and loneliness score (ranging from 3 to 9) was examined using fixed-effect linear regression analysis adjusting for time-varying confounders, including sociodemographic and health characteristics. The prevalence of complete tooth loss was 12.7%, 12.8%, and 10.6% in waves 3, 5, and 7, respectively. Individuals who transitioned to complete tooth loss during any 2 consecutive waves had an increase in loneliness score by 0.27 (95% confidence interval [CI] 0.03, 0.52), which was greater than those who maintained natural teeth (-0.03; 95% CI -0.05, -0.01). Fixed-effects analysis adjusting for time-varying confounders revealed a significant association between complete loss of natural teeth and an increase in loneliness score by 0.31 (95% CI 0.17, 0.46). Complete loss of natural teeth among older adults in England was associated with loneliness, even after accounting for measured time-varying and (un)measured time-invariant confounders. Retaining natural teeth may reduce the risk of loneliness.
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  • 文章类型: Journal Article
    背景:调整混杂变量对于客观比较结果至关重要。调整后的损伤模型中使用的变量的解释力及其在各年龄段的相对效用尚未得到明确定义。本研究旨在评估损伤研究中通常调整的协变量的解释力及其在各年龄段的相对表现。
    方法:从90个医院创伤登记处选择18-100岁(2017-2022年)的住院患者。患者被分组为5岁年龄区间。死亡率定义为“过期+临终关怀”患者的比例。显性分析用于确定多变量逻辑回归中通常包含的协变量的平均贡献(McFadden'sR2)。
    结果:包括397,000名患者(51.1%的男性,平均年龄:63,平均损伤严重程度评分[ISS]:9.8,平均格拉斯哥昏迷评分:14.3,93.5%钝)。死亡率的总解释力(McFadden'sR2)在最年轻的年龄组中最高(18-24岁组的52.7%),并且随着年龄的增长而降低,在95-100组中R2最低(19.6%)。不管年龄,格拉斯哥昏迷评分是最重要的协变量(R2为9.0%~20.4%).18-24岁,国际空间站比Elixhauser分数更主要,但是超过55年,Elixhauser评分比ISS更具优势。
    结论:包括共同协变量在内的调整模型的解释力有限,并且在不同年龄段之间差异很大,随年龄线性下降。使用这些协变量调整结果可能会限制客观比较,尤其是对于老年人。需要进行更多的研究来确定能够增强调整模型解释能力的协变量,以便在所有年龄段进行更客观的比较。
    BACKGROUND: Adjusting for confounding variables is critical for objective comparison of outcomes. The explanatory power of variables used in adjusted models for injury and their relative utility across age groups has not been well-defined. This study aimed to assess the explanatory power of covariates commonly adjusted in injury research and their relative performance across age groups.
    METHODS: Inpatients 18-100 y (2017-2022) were selected from 90 hospital trauma registries. Patients were grouped into sequential 5-y age blocks. Mortality was defined as the proportion of patients \"expired + hospice\". Dominance analysis was used to determine the average contribution (McFadden\'s R2) for covariates commonly included in multivariable logistic regressions.
    RESULTS: Three hundred seventeen-thousand one hundred thirty-six patients were included (51.1% male, mean age: 63, mean injury severity score [ISS]: 9.8, mean Glasgow Coma Scale: 14.3, 93.5% blunt). Total explanatory power (McFadden\'s R2) for mortality was highest in youngest age group (52.7% in 18-24 group) and decreased with age, with the lowest R2 (19.6%) in 95-100 group. Regardless of age, the Glasgow Coma Scale was the most important covariate (R2 ranging from 9.0% to 20.4%). At age 18-24 y, ISS was a more dominant contributor than Elixhauser Score, but beyond 55 y, Elixhauser Score became more dominant than ISS.
    CONCLUSIONS: The explanatory power of adjustment models including common covariates is limited and varies significantly across age groups, decreasing linearly with age. Adjusting for outcomes using these covariates may limit objective comparisons especially for older adults. Additional research is needed to identify covariates that enhance the explanatory power of adjustment models to allow for more objective comparisons across all ages.
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  • 文章类型: Journal Article
    一段时间以来,人们已经探索了代谢组学分析来寻找人类的疾病生物标志物。对动物物种的应用,包括鱼,然而,还在开始。在本研究中,我们已经使用靶向和非靶向代谢组学来鉴定被猪正呼肠病毒(PRV-1)攻击的大西洋鲑鱼(Salmosalar)血浆中的代谢物,旨在寻找与PRV-1感染进展为心脏和骨骼肌炎症(HSMI)相关的代谢物。通过采用不同的生物统计学方法,在疾病发展的三个时间点比较了对照和PRV-1感染的鲑鱼的代谢组。靶向代谢组学导致确定受影响的代谢物和代谢途径,揭示了PRV-1感染对脂质稳态的实质性影响,特别是在几种(lyso)磷脂酰胆碱,神经酰胺,和甘油三酯。非靶向代谢组学显示,在以后的研究时间点,治疗组明显分离,主要是由于对脂质代谢途径的影响。在随后的多组学方法中,我们将两个代谢组学数据集与先前报道的从相同鲑鱼血浆样本产生的蛋白质组学数据相结合.使用DIABLO软件进行数据处理可鉴定出代表鲑鱼中HSMI发育的重要代谢物和蛋白质。
    Metabolomic analysis has been explored to search for disease biomarkers in humans for some time. The application to animal species, including fish, however, is still at the beginning. In the present study, we have used targeted and untargeted metabolomics to identify metabolites in the plasma of Atlantic salmon (Salmo salar) challenged with Piscine orthoreovirus (PRV-1), aiming to find metabolites associated with the progression of PRV-1 infection into heart and skeletal muscle inflammation (HSMI). The metabolomes of control and PRV-1-infected salmon were compared at three time points during disease development by employing different biostatistical approaches. Targeted metabolomics resulted in the determination of affected metabolites and metabolic pathways, revealing a substantial impact of PRV-1 infection on lipid homeostasis, especially on several (lyso)phosphatidylcholines, ceramides, and triglycerides. Untargeted metabolomics showed a clear separation of the treatment groups at later study time points, mainly due to effects on lipid metabolism pathways. In a subsequent multi-omics approach, we combined both metabolomics datasets with previously reported proteomics data generated from the same salmon plasma samples. Data processing with DIABLO software resulted in the identification of significant metabolites and proteins that were representative of the HSMI development in the salmon.
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  • 文章类型: Journal Article
    目标:效用值可以在各种健康状况之间进行相对比较,为医疗资源的有效分配提供信息。这项研究旨在(1)量化日本成年人口腔健康相关生活质量(OHRQoL)的效用值,以及(2)开发将14项口腔健康影响概况(OHIP-14)评分转换为EuroQoL5维5级(EQ-5D-5L)的效用值的模型。
    方法:这是一项横断面研究。分析了2022年对日本成年人进行的大规模互联网调查的数据(n=28405;平均年龄48.2岁)。拟合多元线性回归模型以研究OHIP-14评分与基于EQ-5D-5L的效用值之间的关联,适应混杂因素。转换模型是使用随机的一半参与者开发的,并比较另一半的观察和预测效用值,以评估模型性能。
    结果:在参与者中,在OHIP-14上,55.2%的得分为0,20.9%的得分为1-5,23.9%的得分为6-56,对应的平均效用值分别为0.93、0.90和0.84。OHIP-14评分增加1分与较低的效用值相关(系数:-0.0053;95%置信区间:健康相关生活质量-0.0056,-0.0051)。OHIP-14的估计效用值为-23.3/1000个人,大于其他流行的慢性病,包括高血压和糖尿病(每1000个人-2.9和-7.1,分别)。转换模型结合了OHIP-14总分,年龄,性和自我评价的健康,平均预测效用分数,并根据牙齿脱落的数量捕获差异。然而,在较低效用值组中,预测和观察到的效用值之间存在差异。
    结论:OHRQoL大大影响了人口水平的效用值。OHIP-14具有作为根据口腔健康状况预测平均效用值的有价值工具的潜力;然而,对于健康相关生活质量较低的个体,预测表现相对较低.
    OBJECTIVE: Utility values enable relative comparisons across various health conditions, providing information for efficient allocation of healthcare resources. This study aimed to (1) quantify the utility values attributable to oral health-related quality of life (OHRQoL) in Japanese adults and (2) develop models for converting the 14-item Oral Health Impact Profile (OHIP-14) scores into EuroQoL 5-dimension 5-level (EQ-5D-5L)-based utility values.
    METHODS: This was a cross-sectional study. Data from a large-scale Internet survey of Japanese adults conducted in 2022 (n = 28 405; mean age 48.2 years) were analysed. Multiple linear regression models were fitted to investigate the association between OHIP-14 scores and EQ-5D-5L-based utility values, adjusting for confounders. Conversion models were developed using a random half of the participants, and the observed and predicted utility values in the other half were compared to evaluate the model performance.
    RESULTS: Among the participants, 55.2% scored 0, 20.9% scored 1-5 and 23.9% scored 6-56 on the OHIP-14, corresponding mean utility values of 0.93, 0.90 and 0.84, respectively. A one-point increase in the OHIP-14 score was associated with a lower utility value (coefficient: -0.0053; 95% confidence interval:health-related quality of life -0.0056, -0.0051). The estimated utility value attributable to OHIP-14 was -23.3 per 1000 individuals, greater than that for other prevalent chronic conditions, including hypertension and diabetes (-2.9 and -7.1 per 1000 individuals, respectively). The conversion model incorporated the OHIP-14 total score, age, sex and self-rated health, predicted utility scores on average and captured differences according to the number of teeth lost. However, there was a discrepancy between predicted and observed utility values in the lower utility value groups.
    CONCLUSIONS: OHRQoL substantially impacted utility values at the population level. The OHIP-14 holds the potential as a valuable tool for predicting average utility values based on oral health conditions; however, the prediction performance was relatively low for individuals with a lower health-related quality of life.
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  • 文章类型: Journal Article
    高通量DNA测序技术的快速发展使得大规模全基因组测序(WGS)研究成为可能。在进行表型和基因型之间的关联分析之前,需要对原始序列数据进行预处理和质量控制(QC)。因为到目前为止,许多生物统计学家还没有使用WGS数据,我们首先勾勒出Illumina的短读测序技术。第二,我们解释了WGS研究的一般预处理管道。第三,我们概述了重要的质量控制指标,应用于WGS数据:在原始数据上,映射和对齐后,变体调用后,在多样本变异调用之后。第四,我们用汉堡-达沃斯遗传测序研究(GENESIS-HD)的数据来说明质量控制,一项涉及9000多个人类全基因组的研究。使用无PCR方案在IlluminaNovaSeq6000上对所有样品进行测序,平均覆盖率为35X。对于QC,瓶中的一个基因组(GIAB)三重奏进行了四次重复测序,一个GIAB样本在不同的运行中成功测序了70次。第五,我们提供有关使用DRAGEN原始读取存档(ORA)压缩原始数据的经验数据。应用中最重要的质量指标是遗传相似性,样品交叉污染,与预期Het/Hom比率的偏差,亲缘关系,和覆盖范围。使用DRAGENORA的原始文件的压缩比为5.6:1,压缩时间与基因组覆盖率呈线性关系。总之,预处理,联合召唤,大型WGS研究的质量控制在合理的时间内是可行的,和有效的QC程序是现成的。
    Rapid advances in high-throughput DNA sequencing technologies have enabled large-scale whole genome sequencing (WGS) studies. Before performing association analysis between phenotypes and genotypes, preprocessing and quality control (QC) of the raw sequence data need to be performed. Because many biostatisticians have not been working with WGS data so far, we first sketch Illumina\'s short-read sequencing technology. Second, we explain the general preprocessing pipeline for WGS studies. Third, we provide an overview of important QC metrics, which are applied to WGS data: on the raw data, after mapping and alignment, after variant calling, and after multisample variant calling. Fourth, we illustrate the QC with the data from the GENEtic SequencIng Study Hamburg-Davos (GENESIS-HD), a study involving more than 9000 human whole genomes. All samples were sequenced on an Illumina NovaSeq 6000 with an average coverage of 35× using a PCR-free protocol. For QC, one genome in a bottle (GIAB) trio was sequenced in four replicates, and one GIAB sample was successfully sequenced 70 times in different runs. Fifth, we provide empirical data on the compression of raw data using the DRAGEN original read archive (ORA). The most important quality metrics in the application were genetic similarity, sample cross-contamination, deviations from the expected Het/Hom ratio, relatedness, and coverage. The compression ratio of the raw files using DRAGEN ORA was 5.6:1, and compression time was linear by genome coverage. In summary, the preprocessing, joint calling, and QC of large WGS studies are feasible within a reasonable time, and efficient QC procedures are readily available.
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  • 文章类型: Journal Article
    描述和展示用于具有来自一只或两只眼睛的二元结果的眼科研究的样本量和功效计算。
    我们描述了四种常用眼睛设计的样本量和功率计算:(1)单眼设计或人设计:每个受试者一只眼睛或结果处于人水平;(2)配对设计:每个受试者两只眼睛,两只眼睛处于不同的治疗组;(3)两只眼睛设计:每个受试者两只眼睛,两只眼睛都在同一治疗组中;(4)每个受试者两只眼睛的混合物对于每个设计,我们展示了实际眼科研究中的样本量和功率计算。
    使用公式和商业或免费统计软件包,包括SAS,STATA,R,PS,我们计算了样本量和功率。我们证明了不同的统计软件包需要不同的参数,并提供类似的,但不相同,结果。我们强调,使用受试者两只眼睛的数据进行的研究需要考虑到Intereye相关性,以进行适当的样本量和功率计算。我们展示了与单眼设计相比,包括受试者的两只眼睛的设计的效率增益。
    眼科研究使用不同的眼睛设计,包括相同或不同治疗组中的一只或两只眼睛。适当的样本量和功率计算取决于眼睛设计,并且当来自一些或所有受试者的两只眼睛被包括在研究中时,应该考虑兴趣相关性。可以使用公式和商业或免费统计包执行计算。
    UNASSIGNED: To describe and demonstrate sample size and power calculation for ophthalmic studies with a binary outcome from one or both eyes.
    UNASSIGNED: We describe sample size and power calculation for four commonly used eye designs: (1) one-eye design or person-design: one eye per subject or outcome is at person-level; (2) paired design: two eyes per subject and two eyes are in different treatment groups; (3) two-eye design: two eyes per subject and both eyes are in the same treatment group; and (4) mixture design: mixture of one eye and two eyes per subject. For each design, we demonstrate sample size and power calculations in real ophthalmic studies.
    UNASSIGNED: Using formulas and commercial or free statistical packages including SAS, STATA, R, and PS, we calculated sample size and power. We demonstrated that different statistical packages require different parameters and provide similar, yet not identical, results. We emphasize that studies using data from two eyes of a subject need to account for the intereye correlation for appropriate sample size and power calculations. We demonstrate the gain in efficiency in designs that include two eyes of a subject compared to one-eye designs.
    UNASSIGNED: Ophthalmic studies use different eye designs that include one or both eyes in the same or different treatment groups. Appropriate sample size and power calculations depend on the eye design and should account for intereye correlation when two eyes from some or all subjects are included in a study. Calculations can be executed using formulas and commercial or free statistical packages.
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  • 文章类型: Journal Article
    残疾研究已经成功地关注个人的生活经历,目标的个性化,以及个人在定义疾病和重建公众对残疾的理解方面的宪法。尽管他们在疾病的政策制定和医学建模方面有很大的影响力,他们的框架还没有被翻译成传统的自然主义的疾病解释。我会争辩说,利用进化生物学的新发展(关于适当功能问题的扩展进化综合[EES])和行为生态学(关于生物统计学账户中参考类问题的生态位一致性和建构),残疾研究框架的主要要素可用于在两个主要的“非规范性”疾病描述的概念层面上代表生活史。我选择了这些账户,因为它们以更具描述性的方式与医学有关。以这种方式进行残疾研究的实际方面的成功将在不对个人造成不公正的情况下进行传达,因为它们将在两个主要的自然疾病帐户中代表患者的个性:生物统计学帐户和进化功能帐户。尽管大多数批评疾病概念的说法都没有提供积极因素,残疾研究可以通过纳入认知机构来为该概念的描述性扩展提供一个很好的观点。
    Disability studies have been successfully focusing on individuals\' lived experiences, the personalization of goals, and the constitution of the individual in defining disease and restructuring public understandings of disability. Although they had a strong influence in the policy making and medical modeling of disease, their framework has not been translated to traditional naturalistic accounts of disease. I will argue that, using new developments in evolutionary biology (Extended Evolutionary Synthesis [EES] about questions of proper function) and behavioral ecology (Niche conformance and construction about the questions of reference classes in biostatistics accounts), the main elements of the framework of disability studies can be used to represent life histories at the conceptual level of the two main \"non-normative\" accounts of disease. I chose these accounts since they are related to medicine in a more descriptive way. The success of the practical aspects of disability studies this way will be communicated without causing injustice to the individual since they will represent the individuality of the patient in two main naturalistic accounts of disease: the biostatistical account and the evolutionary functional account. Although most accounts criticizing the concept of disease as value-laden do not supply a positive element, disability studies can supply a good point for descriptive extension of the concept through inclusion of epistemic agency.
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  • 文章类型: Journal Article
    背景:阿哌沙班减少房颤患者中风和其他血栓栓塞事件(ARISTOTLE)和利伐沙班每日一次口服直接因子Xa抑制与维生素K拮抗预防中风和栓塞房颤试验(ROCKET)的结果差异程度-批准阿哌沙班和阿哌沙班的标志性试验分别,对于非瓣膜性AF-受到其方案差异的影响存在争议。选择标准对试验结果的潜在影响通过在来自全球抗凝剂注册中心(GARFIELD)-AF注册的数据中模拟这些试验来评估。
    方法:根据初始ARISTOTLE或ROCKETAF试验的资格,选择来自GARFIELD-AF的维生素K拮抗剂(VKA)和非维生素K口服拮抗剂(NOAC)使用者。使用倾向评分重叠加权Cox模型来模拟治疗组之间的试验随机化。对于每个NOAC和VKA,计算入组2年内卒中或全身性栓塞(SE)的校正HR。
    结果:在服用阿哌沙班的患者中,利伐沙班和VKA,2570、3560和8005有资格获得ARISTOTLE,分别,分别为1612、2005和4368,火箭AF。当选择ARISTOTLE标准时,与VKA相比,阿哌沙班使用者的卒中/SE风险显著较低(HR0.57;95%CI0.34~0.94),而利伐沙班没有降低(HR0.98;95%CI0.68~1.40).选择ROCKETAF标准时,与VKA相比,所有NOAC的安全性和有效性相似.
    结论:在根据ROCKETAF标准选择的高危患者中,与VKA相比,阿哌沙班和利伐沙班的结果相似。而在选择更具包容性的ARISTOTLE标准时出现了差异。我们的结果强调了试验选择标准在解释试验结果中的重要性,并强调了在比较治疗方法时面临的问题,而不是在临床试验中。
    BACKGROUND: The extent to which differences in results from Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) and Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial (ROCKET) atrial fibrillation (AF)-the landmark trials for the approval of apixaban and rivaroxaban, respectively, for non-valvular AF-were influenced by differences in their protocols is debated. The potential influence of selection criteria on trial results was assessed by emulating these trials in data from the Global Anticoagulant Registry in the Field (GARFIELD)-AF registry.
    METHODS: Vitamin K antagonist (VKA) and non-vitamin K oral antagonist (NOAC) users from GARFIELD-AF were selected according to eligibility for the original ARISTOTLE or ROCKET AF trials. A propensity score overlap weighted Cox model was used to emulate trial randomisation between treatment groups. Adjusted HRs for stroke or systemic embolism (SE) within 2 years of enrolment were calculated for each NOAC versus VKA.
    RESULTS: Among patients on apixaban, rivaroxaban and VKA, 2570, 3560 and 8005 were eligible for ARISTOTLE, respectively, and 1612, 2005 and 4368, respectively, for ROCKET AF. When selecting for ARISTOTLE criteria, apixaban users had significantly lower stroke/SE risk versus VKA (HR 0.57; 95% CI 0.34 to 0.94) while no reduction was observed with rivaroxaban (HR 0.98; 95% CI 0.68 to 1.40). When selecting for ROCKET AF criteria, safety and efficacy versus VKA were similar across the NOACs.
    CONCLUSIONS: Apixaban and rivaroxaban showed similar results versus VKA in high-risk patients selected according to ROCKET AF criteria, whereas differences emerged when selecting for the more inclusive ARISTOTLE criteria. Our results highlight the importance of trial selection criteria in interpreting trial results and underline the problems faced in comparing treatments across rather than within clinical trials.
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