-
摘要:
目前, 临床医生开展病因研究的热情逐年高涨。这不仅说明临床医学界越来越注重疾病病因在疾病防治中的作用, 更显现出我国临床医生学术研究视野正日趋开阔。但目前临床医学界普遍对病因观和病因研究方法的复杂性认识不足。本文针对临床医生的需求, 简要介绍流行病学的病因概念、病因分类及病因研究思路, 以帮助医生在进行病因研究前能形成较为完整的顶层设计。
Abstract:Clinicians are enthusiastically involved in etiologic research since they are paying more attention to the effect of etiology in management of disease in recent decades. However, there is a lack of understanding of the etiological view and etiologic research methods of clinical medical field. This article briefly introduces the etiologic concept, classification and research framework in epidemiology, in order to help clinicians to form a more integrated top-level design before the etiologic research.
-
图 1 结核病的病因网络示意图[1]
图 2 病因研究的基本步骤[1]
-
[1] 黄民主, 刘爱忠.临床流行病学[M].第2版.北京:高等教育出版社, 2013:113-124. [2] Peace N. Epidemiology in a changing world:variation, causation and ubiquitous risk factors[J]. Int J Epidemiol, 2011, 40:503-512. doi: 10.1093/ije/dyq257 [3] Kenneth JR, Sander G, Timothy LL. Modern Epidemiology[M]. Third edition.Philadelphia:Lippincott Williams & Wilkins, 2008:4-31. [4] Alex B. Causation and models of disease in epidemiology[J].Stud Hist Philos Biol Biomed Sci, 2009, 40:302-311. doi: 10.1016/j.shpsc.2009.09.006 [5] Mark P. Causes, risks, and probabilities:Probabilistic concepts of causation in chronic disease epidemiology[J]. Prev Med, 2011, 53:232-234. doi: 10.1016/j.ypmed.2011.09.007 [6] Joffe M. The gap between evidence discovery and actual causal relationships[J]. Prev Med, 2011, 53:246-249. doi: 10.1016/j.ypmed.2011.07.011 [7] Flanders WD, Klein M. A general, multivariate definition of causal effects in epidemiology[J]. Epidemiology, 2015, 26:481-489. doi: 10.1097/EDE.0000000000000286 [8] 李富洪, 李红, 陈安涛, 等.归纳推理的多样性效应及其机制探索[J].心理科学进展, 2006, 14:360-367. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=xlxdt200603007 [9] Lenz W, Pfeiffer RA, Kosenow W. Thalidomide and congenital abnormalities[J]. Lancet, 1962, 1:45. http://www.sciencedirect.com/science/article/pii/S0140673662929082 [10] Lenz W. Thalidomide embryopathy in Germany, 1959-1961[J]. Prog Clin Biol Res, 1985, 163C:77-83. http://www.ncbi.nlm.nih.gov/pubmed/3991661 [11] Jörgensen G, Lenz W, Pfeiffer RA, et al. Thalidomide-embryopathy in twins:a collaborative study[J]. Acta Genet Med Gemellol, 1970, 19:205-210. doi: 10.1017/S1120962300025452 [12] 於毓文.临床药物学[M].北京:人民卫生出版社, 1985:69. [13] McBride WG. The teratogenie action of drugs[J]. Med J Aust, 1963, 2:689-692. doi: 10.5694/j.1326-5377.1963.tb17994.x [14] Vandenbroucke JP, Broadbent A, Pearce N. Causality and causal inference in epidemiology:the need for a pluralistic approach[J]. Int J Epidemiol, 2016:dyv341. http://www.ncbi.nlm.nih.gov/pubmed/27524811 [15] 陶秋山, 詹思延, 李立明.流行病学研究中的病因与病因推断[J].中华流行病学杂志, 2004, 25:1000-1003. doi: 10.3760/j.issn:0254-6450.2004.11.021 [16] De Vreese L. Epidemiology and causation[J]. Med Health Care Philos, 2009, 12:345-353. doi: 10.1007/s11019-009-9184-0