老年人脉压变化与全因死亡关联的贝叶斯联合模型应用研究

目的以老年人脉压变化与全因死亡的关联研究为背景,探讨贝叶斯联合模型拟合相互关联的纵向结局与生存结局时的应用策略和统计性能,为类似特征资料的分析提供方法学指导。方法本研究以自然三次样条函数拟合纵向测量脉压的非线性混合效应模型,并采用B样条法构建全死因生存结局的基线风险函数,通过共享的随机效应关联两个过程建立贝叶斯联合模型,运用Gibbs抽样进行模型参数计算,并将贝叶斯联合模型结果与经典两步法联合模型进行比较。结果贝叶斯联合模型结果显示基线脉压越高(α1=0.72, 95%CI:0.43~1.13),第0~3年、3~6年、6~9年脉压升高越快(α21=0.34, 95%CI:0.20~0.45;α22=0.45, 95%CI:0.10~0.75;α23=0.42, 95%CI:0.24~0.62),老年人全因死亡风险越高。贝叶斯法和两步法联合模型在参数点估计方向上具有一致性,贝叶斯法的区间宽度大于两步法。结论当纵向与生存数据存在关联时,贝叶斯联合模型是对纵向与生存数据联合分析合理有效的统计方法。研究显示,老年人基线脉压过高和脉压升高过快均会造成更高的死亡风险。

Which prognostic factors should be used in pulmonary arterial hypertension in elderly patients？

In recent times, the prevalence of pulmonary arterial hypertension creased prevalence of hypertension, diabetes, obesity, arterial stiffness, （PAH） is more commonly seen among elderly populations. The inas well as diastolic dysfunction, may cause endothelial dysfunction and affect pulmonary vasculature. Furthermore, older patients have certain differences in clinical characteristics and outcomes. In this article the special characteristics of aging in PAH patients have been reviewed, while the risk predictors of elderly patients are also discussed.

Epidemiology of pulmonary hypertension in the elderly

1 Introduction Pulmonary hypertension （PH） is a haemodynamic and pathophysiological condition defined as increase in mean pulmonary arterial pressure≥ 25 mmHg at rest as assessed by right heart catheterization （RHC）.