运用倾向性评分方法探讨血栓心脉宁片对冠心病治疗结局的影响(1)
[摘要] 血栓心脉宁片为消栓类药物可治疗血瘀所致的胸痹心痛，在临床广泛用于冠心病的防治。为了解血栓心脉宁片对冠心病患者治疗结局的影响，该研究基于中国中医科学院中医临床基础医学研究所构建的全国18家大型三级甲等医院的电子医疗病历数据库，将使用和未使用血栓心脉宁片的冠心病患者按性别、年龄、入院病情和是否合并心功能不全进行1∶1匹配。匹配后使用血栓心脉宁片患者组(A组)与未使用血栓心脉宁片患者组(B组)均为1 122人。将“痊愈”和“好转”合并定义为治疗有效人群，将“无效”和“死亡”合并定义为无效人群，对治疗结局的有效率进行评价。卡方检验结果显示未平衡混杂因素的情况下，2组冠心病患者的治疗结局有显著的统计学差异(P<0.05)，使用血栓心脉宁片的患者的有效率相对较高。经典Logistic回归结果显示2组间治疗结局的有效率无显著统计学差异；不带协变量的倾向评分加权Logistic回归和带协变量的倾向评分加权Logistic回归对2组间的45个协变量进行了有效平衡，结果显示不仅回归系数大于0，且有显著统计学差异(P<0.05)。结果显示，使用血栓心脉宁片的冠心病患者治疗的有效率较不使用血栓心脉宁片的冠心病患者有效率高，可以提高冠心病患者的临床疗效。由于该研究并不能肯定已将所有可能存在的混杂因素全部平衡，且纳入的研究对象尚不能很好的反应全部医院的整体情况。因此，研究所得结论仅为临床医师治疗冠心病用药提供参考，仍需进一步进行大样本随机对照试验得出更加可靠的结果以指导临床合理有效用药。
[关键词] 倾向性评分； 血栓心脉宁片； 冠心病； 电子病例
[Abstract] Xueshuan Xinmaining tablet is a Chinese patent medicine for treating chest pain caused by blood stasis. It is widely used in clinical prevention and treatment of coronary heart disease. In order to understand the treatment effect of Xueshuan Xinmaining tablet in patients with coronary heart disease， we extracted electronic medical record data from 18 large hospitals nationwide. We matched the coronary artery disease patients with or without Xueshuan Xinmaining tablet treatment on gender， age， condition at admission and whether combined with cardiac insufficiency on a one to one ratio. After matching， both groups， patients using Xueshuan Xinmaining tablet (group A) and patients not using Xueshuan Xinmaining tablet (group B)， ended up with 1 122 people. In order to evaluate the effectiveness of treatment， the endpoint of effective group was defined as ″cure″ and ″better″ while the endpoint of invalid group was defined as ″invalid″ and ″death″. Chi-square test showed a statistical significant difference (P<0.05) between the two groups of patients with coronary heart disease， with a higher efficiency in Xueshuan Xinmaining group. Classic logistic regression analysis showed no statistical significant difference between the two groups on treatment outcome efficiency. Generalized boosted models (GBM) and propensity score(PS) weighted Logistic regression werethen applied to balance 45 variables between the two groups.The results showed a regression coefficient greater than 0 and a statistical significant difference (P<0.05) between the two groups. Based on the existing results of the analysis， we considered that coronary heart disease patients using Xueshuan Xinmaining tablet had a higher efficiency in clinical efficiency than the patients not using Xueshuan Xinmaining tablet. Since this study did not certainly eliminate all the possible confounders and patients from the hospitals included in this study were not yet well represent the overall situation of the source population， the study conclusion only provided drug use reference for clinical doctors for coronary heart disease. Large randomized controlled trials needs to be done for more reliable results to guide clinical rational and effective medication., http://www.100md.com(李园 谢雁鸣 刘艳 赵维)
[关键词] 倾向性评分； 血栓心脉宁片； 冠心病； 电子病例
[Abstract] Xueshuan Xinmaining tablet is a Chinese patent medicine for treating chest pain caused by blood stasis. It is widely used in clinical prevention and treatment of coronary heart disease. In order to understand the treatment effect of Xueshuan Xinmaining tablet in patients with coronary heart disease， we extracted electronic medical record data from 18 large hospitals nationwide. We matched the coronary artery disease patients with or without Xueshuan Xinmaining tablet treatment on gender， age， condition at admission and whether combined with cardiac insufficiency on a one to one ratio. After matching， both groups， patients using Xueshuan Xinmaining tablet (group A) and patients not using Xueshuan Xinmaining tablet (group B)， ended up with 1 122 people. In order to evaluate the effectiveness of treatment， the endpoint of effective group was defined as ″cure″ and ″better″ while the endpoint of invalid group was defined as ″invalid″ and ″death″. Chi-square test showed a statistical significant difference (P<0.05) between the two groups of patients with coronary heart disease， with a higher efficiency in Xueshuan Xinmaining group. Classic logistic regression analysis showed no statistical significant difference between the two groups on treatment outcome efficiency. Generalized boosted models (GBM) and propensity score(PS) weighted Logistic regression werethen applied to balance 45 variables between the two groups.The results showed a regression coefficient greater than 0 and a statistical significant difference (P<0.05) between the two groups. Based on the existing results of the analysis， we considered that coronary heart disease patients using Xueshuan Xinmaining tablet had a higher efficiency in clinical efficiency than the patients not using Xueshuan Xinmaining tablet. Since this study did not certainly eliminate all the possible confounders and patients from the hospitals included in this study were not yet well represent the overall situation of the source population， the study conclusion only provided drug use reference for clinical doctors for coronary heart disease. Large randomized controlled trials needs to be done for more reliable results to guide clinical rational and effective medication., http://www.100md.com(李园 谢雁鸣 刘艳 赵维)