病例对照研究中对照的选择.ppt

对左旋色氨酸进行序列研究 Sequential studies in assessment of L-tryptophan in the United States 嗜酸性粒细胞增多-肌痛综合征 ，1989 Eosinophilia-myalgia syndrome, USA, 1989 问题 Question: 原因是什么？ Cause of syndrome?研究人群 Study base: 全人群，分年龄-性别 Age-sex band of population 问题 Question: 所有品牌都有危险？All brands of tryptophan?研究人群Study base: 左旋色氨酸使用者 Tryptophan users 问题 Question: X品牌所有批次都有问题？ All lots of brand X?研究人群 Study base: 使用X品牌者 Brand X tryptophan users 需要为每名病例选择 1名对照吗？ Should you select 1 control per case 病例数比对照数重要 Case numbers are more important 为每名病例选择≥ 1名对照可以增加统计效力 ≥ 1 control per case can increase statistical power ≥ 4名对照时，统计效力增加得很有限 ≥ 4 does not improve power 5-6名对照在病例数很少时可能有帮助 5 to 6 helps with very low (≤ 10) case numbers ≥2个对照组常常不好 ≥2 control groups to test the same hypothesis is usually a poor idea. 可以考虑采用序列假设 Testing sequential hypotheses is better 某病在一所学校爆发，研究者决定选择临近一所学校学生作对照。For a disease in a school, students from a nearby, similar school are used for controls. 这种方法选择对照如何？Is this a good choice for a control group? 应该如何选择？ What is the proper choice? 如果这所学校所有学生都暴露怎么办？ Suppose every student was exposed? What do you do? 猪链球菌感染病人的病例定义如下。如何选择对照？ Streptococcus suis case definition, what is your control group? 临床诊断病人+接触病猪或死猪 Clinical disease + exposure to a sick or dying pig 研究问题：接触病猪或死猪的RR或OR是多少？ Question: What is the relative risk (OR) of disease for contact with a sick or dying pig? 这种情况下的2X2表 Here is what your 2X2 table will look like Pig exposure Cases Controls + 100% 100% - 0 0 临床诊断病人+接触病猪或死猪 Clinical disease + exposure to a sick or dying pig 研究问题：何种暴露是危险因素？ Question: What type of exposure is a risk factor for infection? 猪链球菌感染病人的病例定义如下。如何选择对照？ Streptococcus suis case definition, what is your control group? 病例和对照的暴露时间相同 Cases and controls are examined for the same referent exposure period 病例在某一时间段内暴露 Cases were exposed during the referent exposure period 病例和对照的暴露时间段必须相同 Referent exposure period must be identical for cases and controls 时间长短相同 Same duration 时间段相同 Same time frame