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系統識別號 U0002-1906201101095700
中文論文名稱 ROC曲線下面積之統合分析法:青光眼診斷之應用
英文論文名稱 Meta Analysis Method for Area under ROC Curve: Application to Glaucoma Diagnosis
校院名稱 淡江大學
系所名稱(中) 數學學系碩士班
系所名稱(英) Department of Mathematics
學年度 99
學期 2
出版年 100
研究生中文姓名 蕭力誠
研究生英文姓名 Li-Cheng Hsiao
電子信箱 rehchocolate@gmail.com
學號 698190286
學位類別 碩士
語文別 中文
口試日期 2011-06-10
論文頁數 50頁
口試委員 指導教授-張玉坤
委員-彭成煌
委員-楊恭漢
中文關鍵字 統合分析  ROC 曲線  ROC 曲線圖形下面積  光電同調斷層掃描儀  青光眼診斷  視神經纖維層 
英文關鍵字 Meta-analysis  ROC Curve  Area under ROC Cure(AUC)  Optical Coherence Tomography(OCT)  Glaucoma Diagnosis  Retinal Nerve Fiber Layer 
學科別分類 學科別自然科學數學
中文摘要 統合分析是將一些議題相關但彼此獨立的臨床實驗之研究結果(大都取材於已發表之期刊論文),以量性加權平均的方法結合統整,用來代表此議題現階段之研究結果,據此評估療效或草擬新的臨床實驗之依據。常用之統合分析方法依資料特性有: 二元資料之相對危險度(Relative Risk)、勝算比(Odds Ratio)及率差(Rates Difference);常態分佈資料之效應量(Effect Size)及統合回歸(Meta Regression)等。至於臨床醫學診斷常用之ROC曲線圖形下面積的統合分析方法,至今尚未被提出。
青光眼是不可逆的視神經病變,其疾病的特色就是漸進性的視神經纖維層(Retinal Nerve Fiber Layer,RNFL)厚度的變薄,其嚴重度可以客觀的由影像檢查儀進行評估,目前眼科是以光電同調斷層掃描儀(Optical Coherence Tomography,OCT)為主。現今發表之文獻以OCT診斷青光眼之診斷力呈現顯著之異質性,所用診斷力指標常以靈敏度(Sensitivity)、特異性(Specificity)及ROC曲線圖形下面積呈現。據此,以隨機效應之統合分析方法,綜合ROC曲線圖形下面積,將有助於呈現以OCT診斷青光眼之整體診斷力。本研究計畫將提出ROC曲線圖形下面積之固定及隨機效應的統合分析方法,並將之應用在以OCT診斷青光眼的研究議題。
英文摘要 Meta-analysis is a quantitative weighted average method to combine the results of related but independent studies (usually drawn from the published literatures) and synthesize summaries and conclusions which may be used to evaluate the therapeutic effects and/or plain new study accordingly. The commonly used meta-analyses, dependent on the characteristic of data, are: the relative risk, odds ratio, and rates difference for binary data and effect size and meta-regression for normally distributed data. Meta-analysis for area under ROC curve (AUC), a commonly used medical diagnosis method, has not been proposed yet.
Glaucoma is an irreversible optic neuropathy, which characterized by progressive retinal nerve fiber layer (RNFL) thinning. Its severity could be evaluated objectively by imaging techniques which mainly by optical coherence tomography (OCT) in current ophthalmology. The diagnostic capacities of OCT for glaucoma were heterogeneous in the current published literatures. Most of them were presented in terms of sensitivity, specificity, and area under ROC curve (AUC). Accordingly, a random effects’ meta-analysis for AUC will be helpful to synthesize the overall diagnostic capacities of OCT for glaucoma. In this study, we are going to propose a fixed/random effects meta-analysis method for area under ROC curve and apply it to glaucoma diagnostic by OCT.
論文目次 中文摘要 I
ABSTRACT II
致謝 III
目錄 IV
圖目錄 V

第一章 緒論 1
第一節 研究背景及目的 1
第二節 研究問題 2
第二章 統合分析 4
第一節 前言 4
第二節 研究步驟 5
第三節 統計方法 6
第四節 統合分析的優點 12
第五節 結論 12
第三章 研究方法 13
第一節 效果量計算 13
第二節 資料分析 15
第四章 研究結果 16
第一節 研究基本資料 16
第二節 Funnel Plot 17
第三節 研究結果 21
第五章 結論與建議 47

參考文獻 48

圖目錄
圖1.2.1:OCT眼球診斷方位相對位置 3
圖4.2.1:Cirrus儀器在Superior方位所測得AUC值的funnel plot 17
圖4.2.2:Cirrus儀器在Nasal方位所測得AUC值的funnel plot 17
圖4.2.3:Cirrus儀器在Inferior方位所測得AUC值的funnel plot 18
圖4.2.4:Cirrus儀器在Temporal方位所測得AUC值的funnel plot 18
圖4.2.5:Cirrus儀器在Average方位所測得AUC值的funnel plot 18
圖4.2.6:Stratus儀器在Superior方位所測得AUC值的funnel plot 19
圖4.2.7:Stratus儀器在Nasal方位所測得AUC值的funnel plot 19
圖4.2.8:Stratus儀器在Inferior方位所測得AUC值的funnel plot 19
圖4.2.9:Stratus儀器在Temporal方位所測得AUC值的funnel plot 20
圖4.2.10:Stratus儀器在Average方位所測得AUC值的funnel plot 20
圖4.3.11:CirrusSuperior在固定效應下之forest plot 21
圖4.3.12:CirrusSuperior在隨機效應下之forest plot 22
圖4.3.13:CirrusNasal在固定效應下之forest plot 23
圖4.3.14:CirrusNasal在隨機效應下之forest plot 24
圖4.3.15:CirrusInferior在固定效應下之forest plot 25
圖4.3.16:CirrusInferior在隨機效應下之forest plot 26
圖4.3.17:CirrusTemporal在固定效應下之forest plot 27
圖4.3.18:CirrusTemporal在隨機效應下之forest plot 28
圖4.3.19:CirrusAverage在固定效應下之forest plot 29
圖4.3.20:CirrusAverage在隨機效應下之forest plot 30
圖4.3.21:StratusSuperior在固定效應下之forest plot 33
圖4.3.22:StratusSuperior在隨機效應下之forest plot 33
圖4.3.23:StratusNasal在固定效應下之forest plot 36
圖4.3.24:StratusNasal在隨機效應下之forest plot 36
圖4.3.25:StratusInferior在固定效應下之forest plot 39
圖4.3.26:StratusInferior在隨機效應下之forest plot 39
圖4.3.27:StratusTemporal在固定效應下之forest plot 42
圖4.3.28:StratusTemporal在隨機效應下之forest plot 42
圖4.3.29:StratusAverage在固定效應下之forest plot 45
圖4.3.30:StratusAverage在隨機效應下之forest plot 45

表目錄
表4.3.1:CirrusSuperior在固定效應下之分析 21
表4.3.2:CirrusSuperior在隨機效應下之分析 22
表4.3.3:CirrusNasal在固定效應下之分析 23
表4.3.4:CirrusNasal在隨機效應下之分析 24
表4.3.5:CirrusInferior在固定效應下之分析 25
表4.3.6:CirrusInferior在隨機效應下之分析 26
表4.3.7:CirrusTemporal在固定效應下之分析 27
表4.3.8:CirrusTemporal在隨機效應下之分析 28
表4.3.9:CirrusAverage在固定效應下之分析 29
表4.3.10:CirrusAverage在隨機效應下之分析 30
表4.3.11:StratusSuperior在固定效應下之分析 31
表4.3.12:StratusSuperior在隨機效應下分析 32
表4.3.13:StratusNasal在固定效應下之分析 34
表4.3.14:StratusNasal在隨機效應下之分析 35
表4.3.15:StratusInferior在固定效應下之分析 37
表4.3.16:StratusInferior在隨機效應下分析 38
表4.3.17:StratusTemporal在固定效應下之分析 40
表4.3.18:StratusTemporal在隨機效應下之分析 41
表4.3.19:StratusAverage在固定效應下之分析 43
表4.3.20:StratusAverage在隨機效應下之分析 44
表4.3.21:固定效應模式下之各研究效應量表 46
表4.3.22:隨機效應模式下之各研究效應量表 46


參考文獻 1.Allingham R et al. (2005). Shields’ Textbook of Glaucoma, 5th Edition. Arch Ophthalmol., p. 124:1213.
2.Anita Manassakorn, Kourosnouri-Mahdavi, Josephcaprioli. (2006, Jan). Comparison of Retinal Nerve Fiber Layer Thickness and Optic Disk Algorithms with Optical Coherence Tomography to Detect Glaucoma. Am J Ophthalmol., pp. 141:105-115.
3.Aptel F, Sayous R, Fortoul V, Beccat S, Denis P. (2010, Dec). Structure-function relationships using spectral-domain optical coherence tomography: comparison with scanning laser polarimetry. Am J Ophthalmol., pp. 150(6):825-33.
4.Badalà F, Nouri-Mahdavi K, Raoof DA, Leeprechanon N, Law SK, Caprioli J. (2007, Nov). Optic Disk and Nerve Fiber Layer Imaging to Detect Glaucoma. Am J Ophthalmol, pp. 144:724–732.
5.Badalà F, Nouri-Mahdavi K, Raoof DA, Leeprechanon N, Law SK, Caprioli J. (2007, Nov). Optic Disk and Nerve Fiber Layer Imaging to Detect Glaucoma. Am J Ophthalmol., pp. 114:724-732.
6.Chen Hsin-Yi, Chang Yue-Cune, and Hsien-Yuan Lane . (2010). Comparison of Glaucoma Diagnosis using Stratus OCT and Cirrus Optical Coherence Tomography in Taiwan Chinese Population. submitted manuscript.
7.Chen HY, Huang ML, Tsai YY, Hung PT. (2007, Jul). Diagnostic value of GDx polarimetry in a Taiwan Chinese population. Optom Vis Sci, pp. 84(7):640-646.
8.Chen HY, Huang ML. (2005, Sep). Discrimination between normal and glaucomatous eyes using Stratus Optical Coherence Tomography in Taiwan Chinese Populatio. Graefes Arch Clin Exp Ophthalmol, pp. 243: 894-902.
9.DerSimonian R, Laird N. (1986). Meta-analysis in clinical trials. Controlled Clin Trials , pp. 7:177-88.
10.Donald L. Budenz, Anika Michael, Robert T. Chang, John McSoley and Joanne Katz. (2005, Jan). Sensitivity and Specificity of the StratusOCT for Perimetric Glaucoma. Ophthalmology, pp. 112 : 3-9.
11.Ferreras A, Pablo LE, Pajarín AB, Larrosa JM, Polo V, Honrubia FM. (2008, Apr). Logistic Regression Analysis for Early Glaucoma Diagnosis Using Optical Coherence Tomography. Arch Ophthalmol, pp. 126(4):465-470.
12.Gadi Wollstein, Hiroshiishikawa, Jiping Wang, Siobahn A. Beaton, BA, Joel S. Schuman. (2005, Jan). Comparison of Three Optical Coherence Tomography Scanning Areas for Detection of Glaucomatous Damage. Am J Ophthalmol, pp. 139:39-43.
13.Gyatsho J, Kaushik S, Gupta A, Pandav SS, Ram J. (2008, Mar). Retinal Nerve Fiber Layer Thickness in Normal, Ocular Hypertensive, and Glaucomatous Indian Eyes An Optical Coherence Tomography Study. J Glaucoma., pp. 17:122-129.
14.Javier Moreno-Montan˜e´s, Natalia Olmo, Aurora Alvarez, Noelia García, and Javier Zarranz-Ventura,. (2010, Jan). Cirrus High-Definition Optical Coherence Tomography Compared with Stratus Optical Coherence Tomography in Glaucoma Diagnosis,. Investigative Ophthalmology & Visual Science, pp. 51: 335-343.
15.Jonathan A. C. Sterne, H. Joseph Newton, Nicholas J. Cox. (2009). Meta-analysis in Stata: an updated collection from the Stata journal. Stata Press, 2009.
16.Leung CK, Cheung CY, Weinreb RN, Qiu Q, Liu S, Li H, Xu G, Fan N, Huang L, Pang CP, Lam DS. (2009, Jul). Retinal Nerve Fiber Layer Imaging with Spectral-Domain Optical Coherence Tomography: A Variability and Diagnostic Performance Study. Ophthalmology., pp. 116:1257-1263.
17.Leung CK, Lam S, Weinreb RN, Liu S, Ye C, Liu L, He J, Lai GW, Li T, Lam DS. (2010, Sep). Retinal Nerve Fiber Layer Imaging with Spectral-Domain Optical Coherence Tomography: Analysis of the Retinal Nerve Fiber Layer Map for Glaucoma Detection. Ophthalmology. , pp. 117:1684-1691.
18.Medeiros FA, Zangwill LM, Bowd C, Vessani RM, Susanna R Jr, Weinreb RN. (2005, Jan). Evaluation of Retinal Nerve Fiber Layer, Optic Nerve Head, and Macular Thickness Measurements for Glaucoma Detection using Optical Coherence Tomography. Am J Ophthalmol, pp. 139:44-55.
19.Mei-Ling Huang and Hsin-Yi Chen. (2005, Nov). Development and Comparison of Automated Classifiers for the Diagnosis of Glaucoma Using Stratus Optical Coherence Tomography,. Investigate Ophthalmology & Visual Science. , pp. 46: 4121-9.
20.Mei-Ling Huang, Hsin-Yi Chen and Jian-Cheng Lin. (2007, Jan). Rule Extraction on Glaucoma detection using summary data from Stratus Optical Coherence Tomography. Investigate Ophthalmology & Visual Science. , pp. 48: 44-50. .
21.Naithani P, Sihota R, Sony P, Dada T, Gupta V, Kondal D, Pandey RM. (2007, Jul). Evaluation of Optical Coherence Tomography and Heidelberg Retinal Tomography Parameters in Detecting Early and Moderate Glaucoma. Invest Ophthalmol Vis Sci. , pp. 48 : 3138-3145.
22.Nouri-Mahdavi K, Nikkhou K, Hoffman DC, Law SK, Caprioli J. (2008, Apr-May). Detection of Early Glaucoma With Optical Coherence Tomography (StratusOCT). J Glaucoma, pp. 17(3):183-188.
23.Paolo Brusini, Maria L. Salvetat, Marco Zeppieri, Claudia. (2006, Oct). Comparison between GDx VCC scanning laser polarimetry and Stratus OCT optical coherence tomography in the diagnosis of chronic glaucoma. Acta Ophthalmologica Scandinavica, pp. 84:650-655.
24.Ramanjit Sihota,Parul Sony, Viney Gupta,Tanuj Dada,and Rajvir Singh. (2006, May). Diagnostic Capability of Optical Coherence Tomography in Evaluating the Degree of Glaucomatous Retinal Nerve Fiber Damage. Invest Ophthalmol Vis Sci., pp. 47 : 2006-2010.
25.Rebecca DerSimonian, and Nan Laird. (1986, September). Meta-analysis in clinical trials. Controlled Clinical Trials, pp. 177-188 .
26.Sehi M, Ume S, Greenfield DS. and Advanced Imaging in Glaucoma Study Group. (2007, May). Scanning Laser Polarimetry with Enhanced Corneal Compensation and Optical Coherence Tomography in Normal and Glaucomatous Eyes. Invest Ophthalmol Vis Sci. , pp. 48:2099-2104.
27.Sommer A, Katz J, Quigley HA, Miller NR, Robin AL, Richter RC, Witt KA. (1991, Jan). Clinically detectable nerve fiber layer atrophy precedes the onset of glaucomatous field loss. Arch Ophthalmol., pp. 109: 77–83.
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