PHN TCH PHNG SAI TI O LNG (Repeated measure ANOVA)

Phn tch phng sai (ANOVA) chun (1 hoc 2 yu t) c dng kim nh trung bnh ca cc s o c lp trong cc th nghim m mi i tng nghin cu ch c o mt ln. Trong nhiu nghin cu y hc m cc i tng c o nhiu ln vi nhiu iu kin hoc nhiu thi im khc nhau, cc s o ph thuc ln nhau, s o trc c nh hng cc s o sau, v vy chng ta khng th dng ANOVA chun m phi dng phn tch ANOVA ti o lng. Thit k ti o lng thng c dng trong cc nghin cu xui thi gian (nghin cu dc) cc i tng c o nhiu ln (v d mun tm hiu s tng tc ca nhm iu tr theo thi gian). Thit k ny cn c dng khi mu nghin cu nh c t i tng tham gia, mi i tng c o nhiu ln vi nhiu iu kin khc nhau nn gim c chi ph nghin cu. S dng ANOVA ti o lng gim s sai lch do kim nh bt cp (php kim T, ANOVA chun) nhiu ln gy ra. Nu so snh cc trung bnh tng cp (s o 1 v 2, s o 2 v 3, s o 3 v 4 ) th mc sai lm s tng ng k v mi ln t gi thuyt khng th mc sai lm ny l 5%, nu mi i tng o 4 ln ta s c 6 cp so snh v mc sai lm s tng n 30%! Gi nh trong phn tch ANOVA chun l phng sai ca cc trung bnh (s o c lp) phi ng nht (cc phng sai gn bng nhau). Trong ANOVA ti o lng ngoi gi nh ng nht ca cc phng sai cn c gi nh tnh ng nht ca cc hip phng sai (do s o trc c nh hng trn s o sau) nn c gi l gi nh s i xng ca ma trn phng saihip phng sai hay gi l php kim nh Sphericity ca Mauchly (trong SPSS). Sau y l v d minh ha v phn tch ANOVA ti o lng trong phn mm SPSS. Mt nghin cu v thi cht st bnh nhn mc thalassemia, mt loi thuc ung thi st (Ferrirox) c so snh vi loi thuc tim truyn di da Desferal. Mi nhm iu tr c 10 bnh nhn. Nh nghin cu mun bit:

1. Hiu qu ca vic thi st cho c 2 loi thuc. 2. C s khc bit v mc thi st gia 2 loi thuc tim v ung hoc gia 2 nhm iu tr 3. C s tng tc gia loi thuc iu tr theo thi gian

Trong thit k ti o lng, c 2 ngun bin thin cn quan tm: Bin thin gia 2 nhm iu tr ( Between-subject factors) Bin thin trong ni b cc i tng (Within-subject factors)

Vi nghin cu ny nhm iu tr l yu t gia cc i tng v thi gian iu tr l yu t trong ni b cc i tng (theo thi gian iu tr).

S liu nghin cu c trnh by trong bng sau: Gm 6 ct : M bnh nhn (1-20), Nhm thuc iu tr (Desferal v Ferrirox), lng ferritin (ng/ml) lc khi u iu tr, sau 3 thng, 6 thng v 9 thng iu tr. Ma_BN NhomDT Khoidau Sau_3thang Sau_6thang Sau_9thang 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Desferal Desferal Desferal Desferal Desferal Desferal Desferal Desferal Desferal Desferal Ferriprox Ferriprox Ferriprox Ferriprox Ferriprox Ferriprox Ferriprox 5000 6000 5500 4500 6500 3500 3000 4000 4500 5000 5000 4000 5500 4500 6500 3500 3000 4000 5500 4500 3700 6400 3200 2800 3000 3400 4500 4000 3500 5000 4300 6100 3200 2500 3200 4600 3800 3000 5000 2400 1900 2300 2700 3300 3200 2800 4100 3100 5000 2700 1700 2100 4000 3100 2300 4200 1800 1500 1500 1900 2300 2400 1700 3300 2900 4300 1900 1500

18 19 20

Ferriprox Ferriprox Ferriprox

4000 4500 3500

3000 4100 2800

2200 3300 2100

1700 2600 1600

Nhp s liu vo SPSS, vo menu: Analyze> General Linear model> Repeated Measures nh sau:

t tn yu t trong ni b i tng (Within-subject Factor Name) l ferritin S mc so snh (Number of levels): 4 Nhn nt Add s thy ferritin(4) xut hin trong vung nh hnh di

Nhn nt Define ta c mn hnh sau:

Dng chut bi c 4 bin: Khoidau, S3thang, S6thang, S9thang, nhp mi tn chuyn c 4 bin qua bn phi ( Within-subjects variables) nh sau:

Nhp hp thoi Options bn di, chuyn ferritin vo bn phi (Display means for) v nhp vo cc : Compare main effects v Statistic Descriptives nh mn hnh sau:

Nhp Continue, Nhn hp thoi Plots ( v biu lng ferritin theo thi gian) , chuyn ferritin vo Horizontal Axis

Nhp nt Add, chuyn ferritin vo Plots bn di nh sau:

Nhp Continue, sau nhp OK s cho kt qu nh sau:

Kt qu u ra (Output)

Bng 1. Tr trung bnh v lch chun ferritin ti 4 thi im

Mean Khoidau Thang_3 Thang_6 Thang_9 4575.00 3975.00 3120.00 2430.00

Std. Deviation 1054.751 1103.046 968.232 917.720

N 20 20 20 20

Bng 1 cho thy s bnh nhn c iu tr l N=20, lng ferritin mu lc khi u l 4575 v gim dn sau 3, 6 v 9 thng iu tr. Phng sai (bnh phng ca SD) gia 4 thi im c v khng ng nht (gn bng nhau). Bng 2. Test kim nh s ng nht ca phng sai v hip phng sai (Mauchly's Test of Sphericity(b)

Kt qu cho thy Epsilon ca Greenhouse-Geisser=0,703 v p=0,025, nh vy bc b gi thuyt khng, c ngha kim nh Sphericity b vi phm (khng c s ng nht v phng sai-hip phng sai). Trong SPSS, nu gi nh Sphericity b vi phm, ta c th s dng 1 trong 3 loi hiu chnh sau: Greenhouse-Geisser, Huynh-Feldt, Lower-bound. Bng 3. Kt qu kim nh trong ni b cc i tng vi 3 loi hiu chnh (Greenhouse-Geisser, Huynh-Feldt v Lower-bound)

Nu gi nh sphericity khng vi phm (p>0.05) ta c kt qu hng u (Sphericity Assumed) vi bc t do (df)=3, F=379.154 v p=0.000 Nu gi nh sphericity b vi phm (p<0.05) ta c kt qu hng 2 (Greenhouse-Geisser) vi bc t do (df) hiu chnh =2.109, F=379.154 v p=0.000. Nh vy c 3 loi hiu chnh u cho kt qu nh nhau (F=379.154 v p=0.000), ta c th kt lun lng ferritin mu ti 4 thi im l khc nhau r rt. Mun xem s khc bit ti thi im no xem so snh bt cp tng thi im bng 4. Bng 4. So snh bt cp

Kt qu cho thy lng ferritin ti 4 thi im u khc bit r rt (1 khc 2, 2 khc 3, 3 khc 4 v 4 khc 1) vi p=0.000.

Cui cng chng ta c th xem biu (nhn hp thoi Plots) lng ferritin theo thi gian:

By gi mun so snh s khc bit gia 2 nhm iu tr: Tin hnh trnh t y nh trn, tuy nhin phi nhp chuyn Nhomdt . vo Between-Subjects Factors

Nhp hp thoi Plots m mn hnh sau:

Chuyn ferritin vo Horizontal Axis v Nhomdt vo Separate Lines, sau nhp Add chuyn vo Plots bn di. Nhp Continue, nhp hp thoi Options vo mn hnh sau:

Nhp chuyn bin nhomdt, ferritin vo Display Means, nh du vo cc Descriptive Statistic v Homogeneity tests. Sau nhp Continue, vo hp thoi Post Hoc v nh du vo cc (Bonferroni, Dunnett, Dunnees T3) nh hnh sau:

Nhp Continue tr v mn hnh chnh v cui cng nhp OK

Ta c kt qu sau y: Bng 5. Lng ferritin trung bnh v SD ti 4 thi im ca 2 loi thuc iu tri (Desferal v Ferrirox)

Bng 6. Kim nh tnh ng nht phng sai v hip phng sai (Ga nh Sphericity)

Gi nh Sphericity khng b vi phm (p=0.061)

Bng 7. Kt qu ca kim nh trong ni b cc i tng

V gi nh Sphericity khng vi phm, c kt qu hng u tin: Sphericity Assumed: df=3, F=386.518, p=0.000, nh vy lng ferritin khc bit gia 4 thi im Khng c s tng tc gia loi thuc iu tr v thi gian (ferritin*Nhomdt) vi p=0,262 Bng 8. Kim nh gia 2 nhm iu tr

Kt qu: F=0,234 v p=0.634, khng c s khc bit gia 2 loi thuc iu tr

Bng 9. S khc bit trung bnh gia 2 loi thuc

Sai bit trung bnh (Mean Difference) gia 2 nhm iu tr =220 v p=0,634 . Khng c s khc bit gia 2 nhm iu tr V biu cho thy lng ferritin gim dn cho c 2 nhm iu tr v khng c s tng tc theo thi gian ( 2 ng biu din gn song song nhau)

Kt lun: C 2 loi thuc thi st tim (Desferal) v ung (Ferrirox) u c hiu qu iu tr (gim lng ferritin mu) v khng c s khc bit gia 2 loi thuc ny TS Nguyn Ngc Rng, bsrang.blogspot.com Ti liu tham kho: 1. Repeated Measures ANOVA Using SPSS. The University of Texas at Austin Statistical Services, available on line at: http://www.utexas.edu/cc/docs/stat38.html 2. Chan Y. H. Repeadted Measurement Analysis. Singapore Med J 2004, Vol 45 98): 354