Procedures for estimating growth rates in thoracic aortic aneurysms
Procedures for estimating growth rates in thoracic aortic aneurysms
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DOI：
10.1016/s0895-4356(98)00050-x
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发表时间：
1998-09-01
影响因子：
7.2
通讯作者：
Elefteriades, JA
中科院分区：
文献类型：
--
作者：
Rizzo, JA;Coady, MA;Elefteriades, JA
胸主动脉瘤（TAAs）是一种具有潜在致命性的医学疾病，通常需要手术干预。可靠的TAA生长速度和相关危险因素信息对于管理这一具有挑战性的患者群体非常重要。不幸的是，许多研究采用了有问题的统计方法，导致有偏见和不精确的估计。本研究描述了现有研究中的这些统计问题，并描述了获得更可靠结果的程序。使用耶鲁大学胸主动脉疾病中心的数据，该研究比较了使用传统方法估计的TAA增长率与推荐的工具变量（IV）估计方法。IV方法旨在减轻现有TAA增长估计中固有的测量误差问题。结果表明，IV估计可以对TAA增长率和TAA增长的风险因素进行更稳健和精确的估计。例如，传统方法的TAA生长率波动很大，从0.12 cm/年到0.90 cm/年，这取决于(1)纳入研究的患者的最短连续随访时间，以及(2)如何处理生长率为负的受试者。相比之下，使用IV方法估算的增长率更为稳健，范围为0.12至0.13厘米/年。使用IV方法估计TAA增长的95%置信区间也更加紧凑。我们得出的结论是，IV估计程序比传统方法产生更可靠的TAA增长估计。临床流行病学[J]；9:747 - 754, 1998。(C) 1998爱思唯尔科学有限公司
Thoracic aortic aneurysms (TAAs) are potentially lethal medical conditions often requiring surgical intervention Reliable information on TAA growth rates and associated risk factors is important for managing this challenging patient population Unfortunately, a number of studies have employed questionable statistical methods, leading to biased and imprecise estimates. The present study describes these statistical problems in existing studies and delineates procedures for obtaining more reliable results. Using data from the Yale Center for Thoracic Aortic Disease, the study compares TAA growth rate estimates using conventional methods versus the recommended approach of instrumental variables (IV) estimation. The IV approach is designed to mitigate problems of measurement errors inherent in existing estimates of TAA growth. The results demonstrate that IV estimation yields more robust and precise estimates of TAA growth rates and risk factors for TAA growth. For example, the conventional approach yields TAA growth rates that fluctuate substantially-from 0.12 cm/ yr to 0.90 cm/yr-depending on (1) the minimum serial follow-up period for patient inclusion in the study and (2) how subjects with negative measured growth rates are handled. In contrast, growth rate estimates using the IV approach are much more robust, ranging from 0.12 to 0.13 cm/yr. The 95% confidence intervals of estimated TAA growth are much more compact using the IV approach as well. We conclude that the IV estimation procedure yields more reliable estimates of TAA growth than does the conventional approach. J CLIN EPIDEMIOL 51;9:747-754, 1998. (C) 1998 Elsevier Science Inc.