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应用实例分析.ppt

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学习目标内容胎源性疾病/发育源性疾病(DOHAD)流行病学-重要作用之一发现新联系（DOHAD）OBJECTIVE:Todiscoverwhetherreducedfetalandinfantgrowthisassociatedwithnon-insulindependentdiabetesandimpairedglucosetoleranceinadultlife. DESIGN:Followupstudyofmenbornduring1920-30whosebirthweightsandweightsat1yearwereknown. SETTING:Hertfordshire,England. SUBJECTS:468menbornineastHertfordshireandstilllivingthere.Menknowntohavediabeteswereexcluded. MAINOUTCOMEMEASURES:Fastingplasmaglucose,insulin,proinsulin,and32-33splitpro-insulinconcentrationsandplasmaglucoseandinsulinconcentrations30and120minutesaftera75gglucosedrink. RESULTS:93menhadimpairedglucosetoleranceorhithertoundiagnoseddiabetes.Theyhadhadalowermeanbirthweightandalowerweightat1year.Theproportionofmenwithimpairedglucosetolerancefellprogressivelyfrom26%(6/23)amongthosewhohadweighted18lb(8.16kg)orlessat1yearto13%(3/24)amongthosewhohadweighed27lb(12.25kg)ormore.Correspondingfiguresfordiabeteswere17%(4/23)andnil(0/24).Plasmaglucoseconcentrationsat30and120minutesfellwithincreasingbirthweightandweightat1year.Plasma32-33splitproinsulinconcentrationfellwithincreasingweightat1year.Allthesetrendsweresignificantandindependentofcurrentbodymass.Bloodpressurewasinverselyrelatedtobirthweightandstronglyrelatedtoplasmaglucoseand32-33splitproinsulinconcentrations. CONCLUSIONS:Reducedgrowthinearlylifeisstronglylinkedwithimpairedglucosetoleranceandnon-insulindependentdiabetes.Reducedearlygrowthisalsorelatedtoaraisedplasmaconcentrationof32-33splitproinsulin,whichisinterpretedasasignofbetacelldysfunction.Reducedintrauterinegrowthislinkedwithhighbloodpressure,whichmayexplaintheassociationbetweenhypertensionandimpairedglucosetolerance. Questions问题(1) Questions问题(2) *Oddsratiofortwohourglucoseconcentrationof>7.8mmol/ladjustedforcurrentbodymassindex. AnswerstoQuestions（1） Forcohortstudydata,youcanuselogbinomialmodel,toobtaintheadjustedRR. 队列研究的数据，您可以使用log二项式模型，得到调整后的RR。 AnswerstoQuestions（2） 真理？假象？ Birthweight出生体重ConfounderorEffectMediator?混杂因素,或影响介质?Whenyouinappropriateadjustforafa