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个体化心血管医学:概念与方法学考虑。

Personalized cardiovascular medicine: concepts and methodological considerations.

机构信息

Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany. voelzke@ uni-greifswald.de

出版信息

Nat Rev Cardiol. 2013 Jun;10(6):308-16. doi: 10.1038/nrcardio.2013.35. Epub 2013 Mar 26.

Abstract

The primary goals of personalized medicine are to optimize diagnostic and treatment strategies by tailoring them to the specific characteristics of an individual patient. In this Review, we summarize basic concepts and methods of personalizing cardiovascular medicine. In-depth characterization of study participants and patients in general practice using standardized methods is a pivotal component of study design in personalized medicine. Standardization and quality assurance of clinical data are similarly important, but in daily practice imprecise definitions of clinical variables can reduce power and introduce bias, which limits the validity of the data obtained as well as their potential clinical applicability. Changes in statistical methods with personalized medicine include a shift from dichotomous outcomes towards continuously measured variables, predictive modelling, and individualized medical decisions, subgroup analyses, and data-mining strategies. A variety of approaches to personalized medicine exist in cardiovascular research and clinical practice that might have the potential to individualize diagnostic and therapeutic procedures. For some of the emerging methods, such as data mining, the most-efficient way to use these tools is not yet fully understood. In addition, the predictive models-although promising-are far from mature, and are likely to be greatly improved by using available large-scale data sets.

摘要

个性化医学的主要目标是通过针对个体患者的特定特征来优化诊断和治疗策略。在这篇综述中,我们总结了个性化心血管医学的基本概念和方法。使用标准化方法对研究参与者和一般实践中的患者进行深入特征描述是个性化医学研究设计的关键组成部分。临床数据的标准化和质量保证同样重要,但在日常实践中,临床变量的不精确定义会降低效力并引入偏差,从而限制所获得数据的有效性及其潜在的临床适用性。随着个性化医学的发展,统计学方法也发生了变化,包括从二项式结果向连续测量变量、预测模型以及个体化医疗决策、亚组分析和数据挖掘策略的转变。心血管研究和临床实践中存在多种个性化医学方法,这些方法有可能实现诊断和治疗程序的个体化。对于一些新兴方法,如数据挖掘,目前还不完全清楚如何最有效地使用这些工具。此外,尽管预测模型很有前景,但还远未成熟,并且通过使用现有的大规模数据集,它们很可能会得到极大的改进。

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