广药选修药物流行病学第5章-实验流行病学.ppt

学习目的 实验流行病学的定义 实验流行病学的特点 实验流行病学的分类 实验流行病学的设计 实验流行病学的强势与弱势 1747年 苏格兰医师James Lind首次对比研究了用桔子、柠檬及其他干预治疗坏血病的疗效 1816年 法国Hamilton医师首次报道了爱丁堡的一项大型对照实验，评价放血疗法的效果，这是迄今为止有关采用交替法产生对照的最早记载之一。 ‘It had been so arranged, that this number was admitted, alternately, in such a manner that each of us had one third of the whole. The sick were indiscriminately received, and were attended as nearly as possible with the same care and accommodated with the same comforts. One third of the whole were soldiers of the 61st Regiment, the remainder of my own (the 42nd) Regiment. Neither Mr Anderson nor I ever once employed the lancet. He lost two, I four cases; whilst out of the other third [treated with bloodletting by the third surgeon] thirty five patients died. 1898年 丹麦医师Fibiger通过半随机对照实验验证血清治疗白喉的效果。 8 out of 239?patients in the serum treated group and 30?out of 245?in the control group died. No formal statistical analysis was performed but no objection can be raised against the statistical significance of the numbers, which were deemed correct by an inspector of the sick benefit association (in 1900?Pearson invented the 2 test,10 which would have shown P=0.0003). The rate of serum sickness was high at 60%.  Tables - 2-by-2 unstratified 11:44:19, 2011-4-22 | + - | Total -------+-------------+------- + | 8 231 | 239 - | 30 215 | 245 -------+-------------+------- Total | 38 446 | 484 Tests of significance Fisher exact test (one tailed) : 0.000187 Fisher exact test (two tailed) : 0.000289 Uncorrected chi-square : 13.24 p-value : 0.000275 Yates corrected Chi-square : 12.04 p-value : 0.000522 Measures of exposure effect [95% CI] Risk ratio : 0.27 [0.13, 0.58] Odds ratio : 0.25 [0.11, 0.55] Risk