本文關鍵詞： 延遲時間理論 疾病預防 篩查策略 風險分析　出處：《北京科技大學》2017年博士論文　論文類型：學位論文

【摘要】：篩查作為疾病預防的重要手段,主要是在健康或無明顯癥狀人群中實施定期篩查策略,從而實現(xiàn)對于疾病或風險的早期識別,促進人類健康。國內(nèi)外各國對于少數(shù)幾種疾病已頒布了各自的篩查指南,然而大多數(shù)疾病的篩查策略仍存在很大爭議。因此,疾病篩查策略的制定和評估成為篩查研究中一個重要問題。篩查策略一般包括三個方面:篩查方法、篩查起止時間和篩查周期。選擇性篩查除這三個方面之外,還包括對高危風險人群的識別。本文針對目前整群篩查中的篩查策略的建模和選擇性篩查中疾病的風險評估研究中存在的不足,考慮延遲時間理論在建模方面的優(yōu)勢,將其由設備的預防性維修領域擴展到疾病的預防性篩查策略領域中。分別進行了篩查周期、篩查方法和篩查周期、篩查起始時間和篩查周期、篩查人群方面的研究。(1)考慮篩查方法的不完美性和疾病的窗口期對于篩查結果的影響,以性傳播疾病為例,基于延遲時間理論建立了單篩查方法的情況下對篩查周期進行優(yōu)化的成本模型。在成本中包括了篩查成本、與延遲診斷相關的治療成本和在感染后篩查前傳染其他人的成本。在算例研究中對模型的有效性進行了驗證,并通過模型優(yōu)化結果的比較和不完美篩查概率的敏感性分析,證明了窗口期和不完美篩查對篩查策略的期望總成本和篩查周期的影響。(2)考慮普通篩查方法和完美篩查方法在篩查的成本和篩查率上的差別,以癌癥為例,基于延遲時間理論分別建立了三種篩查方案下對篩查周期進行優(yōu)化的成本模型。這三種篩查方案分別為只進行普通篩查、只進行全面篩查以及普通篩查與全面篩查相結合的方案�？偝杀境税ㄆ胀êY查的成本、全面篩查的成本、癌癥檢出后與延遲診斷時間相關的治療成本,還包括了由于癌癥早死造成的壽命折損成本。利用具體算例對模型的有效性進行了驗證,并通過對三種篩查方案優(yōu)化結果的比較,表明了普通篩查與全面篩查相結合的篩查方案優(yōu)于只使用一種篩查方法的篩查方案。(3)考慮疾病發(fā)病率與年齡密切相關的特點以及人群中的知曉率和控制率較低的情況,以高血壓為例,基于延遲時間理論建立了對篩查起始時間和篩查周期進行聯(lián)合優(yōu)化的兩階段檢出率模型和兩階段發(fā)病率模型。其中第一個階段為時間間隔較長的一次性篩查,第二階段為第一次篩查后的時間間隔較短的重復性篩查。這樣第一階段的時間間隔即為篩查起始時間,第二階段的時間間隔為篩查周期。算例結果表明,相比于一階段的篩查策略,兩階段的篩查策略具有更低的成本,更好的效果。(4)考慮疾病風險因素在不同階段的作用、兩階段生存時間的相關性、延遲診斷以及非隨機刪失問題,以丙肝為例,基于延遲時間理論和生存分析方法,分別建立了隨機刪失和非隨機刪失情況下對風險因素進行估計的兩階段生存時間模型。利用風險函數(shù)的改變,然后結合自助法和多重填補法,對非隨機刪失的數(shù)據(jù)進行填補可以將不同程度的非隨機刪失影響納入到模型中。仿真研究表明當兩階段生存時間是相關的、診斷存在延遲以及存在不同程度的非隨機刪失的情況下,在模型中忽略這些因素會使得風險因素的參數(shù)估計產(chǎn)生不可忽視的偏倚,從而導致對于高危風險人群的錯誤識別和生存時間的錯誤估計。通過以上研究,對延遲時間理論進行了豐富和擴展,將其由設備可靠性領域擴展到人群健康領域,為疾病篩查策略的制定提供新的科學決策模型和方法,克服了以往研究的不足,對現(xiàn)有的疾病篩查研究的對象進行擴展,探討疾病篩查策略在多種類型疾病中的建模方法,篩查策略的優(yōu)化有利于實現(xiàn)疾病的早診斷、早發(fā)現(xiàn)、早治療,降低疾病的發(fā)病率,提高患者生存率,降低社會的醫(yī)療負擔,提高人群的健康水平。
[Abstract]:As an important means of screening for disease prevention, mainly the implementation of regular screening strategies in health or no obvious symptoms of the crowd, so as to achieve early recognition for the disease or the risk, the promotion of human health. The domestic and foreign countries for a few diseases have enacted their own screening guidelines, however, remains controversial screening strategies for most diseases. Therefore, the formulation and evaluation of disease screening strategy has become an important problem in the study. Screening screening strategies generally include three aspects: screening, screening and screening time period. Selective screening in addition to these three aspects, including identification of high risk population. In this paper, aiming at the existing problems of research on risk assessment of disease modeling and selective screening screening strategies for the screening of the cluster in the consideration of delay time theory in modeling the advantages of the equipment Preventive maintenance areas extend to the field of preventive screening strategies were carried out. The disease screening cycle, screening methods and periodic screening, starting time and period of screening, screening research aspects. (1) considering the effect of screening method is not perfect and the window period for disease screening results, with sexual transmission the disease as an example, the delay time is established based on the theory of single screening method under the condition of cost optimization model for screening cycle. Based on the cost includes the cost of screening and treatment costs associated with delayed diagnosis and screening after infection infectious to others. In the calculation of the cost of the validity of the model in the study of cases verify, and through sensitivity analysis of optimization model and compare the results of imperfect screening probability, and proves the effect of the window period and imperfect screening for screening strategies of the expected total cost and cycle (screening. 2) consider different common screening methods and perfect screening methods in the cost of screening and screening rate, in cases of cancer, three screening methods were established respectively under the theory of delay time cost optimization model for screening. This cycle based on three screening methods were only conventional screening, only a comprehensive screening and the general screening and comprehensive screening combination scheme. The total cost including the cost of screening in general, comprehensive screening costs, treatment costs associated with delayed diagnosis time after detection of cancer, including life expectancy loss due to premature death. The cost of cancer using specific example the validity of the model was verified, and through comparison of three kinds of optimization results show that the scheme of screening, screening and screening screening scheme is better than ordinary comprehensive screening combined only using a screening method. (3) consider the disease Know the characteristics of disease rate is closely related to the age and the population rate and control rate are lower, with hypertension as an example, the delay time is established based on the theory of two stages of the joint optimization of screening starting time and period of screening detection rate model and two stage model based on the incidence rate. The first stage is a one-time screening time the second stage is long, repeated screening of the first screening after the time interval is short. So the first stage that is the time interval for screening the start time, the second phase of the time interval for screening period. The results show that the screening strategy compared to the stage, the two stage of the screening strategy has lower cost and better effect. (4) consider the disease risk factors in different stages, correlation with the survival time of the two phase, delayed diagnosis and non random censoring problem in C for example, base Yu Yanchi's theory of time and survival analysis method, were established for random censoring and survival time of the two stage model non random censoring of the risk factors were estimated. The risk function of the change, and then combined with the bootstrap method and multiple imputation method for non random censored data can fill the non random censoring effect different degree into the model. The simulation results show that when the two stage is related to the survival time, the delay of diagnosis, there are different degrees of non random censoring case, ignoring these factors will make the parameters of risk factors estimation bias can not be ignored in the model, which leads to error identification and survival the time people at high risk for error estimation. Through the above research, the delay time of theory to enrich and expand the field of equipment reliability, by extension to human health. The domain, to provide scientific decision-making model and new method for the development of disease screening strategies, to overcome the shortcomings of previous studies, objects of disease screening study of the existing modeling methods of extended disease screening strategies in various types of diseases, optimal screening strategy is conducive to the realization of the disease early diagnosis, early discovery, early treatment reduced the incidence of disease, improve the survival rate of patients, reduce the social burden of medical care, improve the health level of people.

【學位授予單位】：北京科技大學
【學位級別】：博士
【學位授予年份】：2017
【分類號】：R195.4

【參考文獻】

相關期刊論文 前10條

1 李洪;謝宜羚;李曉旭;羅春亮;周夢雪;;2015年重慶市綦江區(qū)性病疫情分析[J];職業(yè)與健康;2017年02期

2 劉妞;胡尚英;張倩;劉遠立;喬友林;;全球子宮頸癌篩查指南析評[J];癌癥進展;2016年12期

3 李小剛;王建豐;陳莉;項偉艷;王登杰;王震華;吳云霞;王濰;;結直腸腫瘤伺機性篩查和人群篩查的成本效果分析[J];胃腸病學;2016年09期

4 湯少開;莊錦鎮(zhèn);何婉蘋;梁容嬌;葉興東;;廣州市性病防治工作質(zhì)量分析[J];中國公共衛(wèi)生管理;2016年04期

5 Meng Wang;Changqing Hao;Qing Ma;Guohui Song;Shanrui Ma;Deli Zhao;Lin Zhao;Xinqing Li;Wenqiang Wei;;DNA image cytometry test for primary screening of esophageal cancer: a population-based multi-center study in high-risk areas in China[J];Chinese Journal of Cancer Research;2016年04期

6 Yu-Qiong Yang;Jia Li;Hong-Feng Yuan;;Epidemiology and risk factors of retinoblastoma in Chongqing area[J];International Journal of Ophthalmology;2016年07期

7 賈琳;;慢性阻塞性肺疾病合并心血管疾病的危險因素分析[J];當代護士(上旬刊);2016年07期

8 白文海;宋書儀;林志紅;李真;;深圳市南園社區(qū)性病干預的效果評價[J];社區(qū)醫(yī)學雜志;2016年11期

9 封任冬;汪華;丁瑩瑩;李潤明;王瑞蘭;曹志堅;高琨;;乳腺癌篩查模式的探討[J];臨床放射學雜志;2016年01期

10 鄭良楷;孔令員;張愛格;田瑞華;李清;江雨;賴院清;黃宗涌;楊毅斌;;宮頸高級別病變篩查中LCT和高危型HPV聯(lián)合檢測的價值評價[J];中國婦產(chǎn)科臨床雜志;2016年01期

，

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