THNG K Y HC

GII THIU PHNG PHP PHN TCH BAYES

Phn 1: Din gii kt qu chn on
Nguyn Vn Tun*

Tm tt: Phng php phn tch d liu c in v

ph bin da vo l thuyt phn chng, nhng l mt
phng php c nhiu khim khuyt vn c ch ra
ngay t khi phng php ny ra i vo khong 100 nm
trc. Trong vi thp nin gn y, phng php phn tch
Bayes cng ngy cng ph bin v t c nhiu
thnh cng ngon mc trong di truyn hc, nghin cu khoa
hc v nghin cu lm sng. Bi vit ny gii thiu ng
dng phng php phn tch Bayes trong vi trng hp
lm sng.
Summary: The traditional frequentist methodology of
data analysis relies on the concept of proof by contradiction.
This methodology has several flaws and deficiencies which
have been pointed out since its inception about 100 years
ago. In recent decades, the Bayesian methodology has
regained its prominence as an alternative approach to
scientific inference and data analysis. The Bayesian
methodology has proven a great success in genetics,
scientific research, and clinical research. In this article, I
introduce the basic concept of Bayesian inference via two
cases of clinical diagnosis.

Hai trng hp lm sng

Trng hp 1. N, 47 tui, t pht hin mt u
nh bn v tri v ch quan ngi l bu ung th
nn n gp bc s. Sau khi khm tng qut v xem
xt tin s gia nh, bc s ngh ch i chp nh
nh. Kt qu nh nh l dng tnh. Ch mun bit
nguy c ch mc bnh ung th v l bao nhiu. Bc
s nn tr li nh th no?
Trng hp 2. Nam bnh nhn, 60 tui, sc khe
bnh thng, BMI 23 kg/m2, khng c tin cn gia
nh vi bnh tiu ng. Tuy nhin kt qu xt
nghim glucose trong mu l 127 mg/dL. Theo tiu
chun do ADA ngh, ng c chn on l tiu
ng, nhng ng khng tin. ng mun bit nguy
c tht mnh mc bnh tiu ng. Bc s nn c li
khuyn no cho bnh nhn?
C th ni hai trng hp trn rt tiu biu trong
lm sng. Trc mt xt nghim nh nh nh vi kt
qu dng tnh, v bit rng phng php xt
nghim c nhng hn ch v chnh xc, ngi bc
s cng nh bnh nhn mun bit kh nng mnh
mc bnh l cao hay thp. Tng t, i vi cc kt
qu xt nghim khng c gi tr nh phn m l mt
dy gi tr nh nng glucose trong mu, v kt
qu xt nghim gn ngng chn on bnh, ngi
thy thuc phn vn khng bit nn ra mc bnh hay
*Vin nghin cu y khoa Garvan Sydney, Australia

30

khng mc bnh, bi v ai cng bit rng bt c xt

nghim no cng khng hon ho. Hai trng hp
tiu biu trn cng ni ln mt c im ca y hc
hin i: l tnh bt nh trong bt c o lng
no, bt c xt nghim no, v do bt c chn
on no. Ch th m ng t y khoa William Osler
tng ni y khoa l mt khoa hc bt nh v mt
ngh thut xc sut (medicine is a science of
uncertainty and an art of probability).(1)
X l tnh trng bt nh i hi n khoa hc.
X l xc sut cn phi c ngh thut. Trong vi
nm gn y, mt phng php phn tch mi ra
i v ang dn tr thnh ph bin trong nghin cu
khoa hc v nghin cu lm sng c th p ng hai
nhu cu v khoa hc v ngh thut. Ni l mi
nhng trong thc t th khng mi, bi v c s l
thuyt ca phng php ny ra i t th k 18.
l suy lun theo trng phi Bayes (Bayesian
inference) do Thomas Bayes xut vo nm
1763.(2) Thomas Bayes l mt linh mc, nhng cng
l mt nh ton hc ti t. Tuy l ti t nhng di
sn ca ng li (ch mt bi bo duy nht) lm
thay i c th gii khoa hc, thay i cch suy ngh
v s bt nh trong khoa hc, v ch ra mt phng
php suy lun hon ton logic. Ngy nay, phng
php Bayes c ng dng trong hu ht tt c lnh
vc khoa hc, k c trong cng ngh thng tin (ng
dng Bayes trong vic ngn chn nhng th rc in
t), tin lng kinh t, phn tch cc mi quan h x
hi, v l gii qui trnh suy ngh ca con ngi.
Ngy nay, suy lun theo trng phi Bayes c
nhc n trn bo ch i chng ch khng ch trong
bo khoa hc. Nhng t bo ln nh New York
Times, Economist, Guardian, v.v. u thng xuyn
nhc n phng php suy lun Bayes.
Suy lun Bayes da vo nh l Bayes (Bayesian
theorem). C th pht biu nh l Bayes theo ngn
ng hng ngy nh sau: nhng g chng ta bit l
tng hp nhng g chng ta bit cng vi chng
c thc t. C th ni rng nh l Bayes th hin
cch suy ngh rt ph bin ca tt c chng ta: l
chng ta tip thu kin thc theo kiu tch ly. Trong
hai trng hp trn, trc khi gi bnh nhn i xt
nghim, chng ta bit c kh nng bnh nhn
mc bnh nh th no (qua cc thng tin v t l
THI S Y HC 07/2011 - S 62

THNG K Y HC

hin hnh trong cng ng), sau khi c kt qu xt

nghim chng ta c thm chng c thc t, v hai
thng tin ny gip cho chng ta nh gi li kh
nng mc bnh ca bnh nhn.
nh l Bayes d nhin cng c th m t mt
cch n gin qua xc sut. Gi H l bnh trng, v
D l chng c (c th l kt qu xt nghim hay d
liu), nh l Bayes pht biu rng xc sut H vi
iu kin D xy ra k hiu P(H | D) l:
P D | H P H
P H | D
[1]
P D
trong
P(H) l kh nng mc bnh trc khi xt
nghim; v
P(D | H) l xc sut kt qu dng tnh vi
iu kin c bnh H;
P(D) l phn b ca d liu.
Nhn qua nh l trn, chng ta thy suy lun
Bayes c 3 thng tin. Thng tin th nht l thng
tin m chng ta mun bit, thut ng ting Anh gi
l posterior information thng tin hu nh.
Thng tin th hai l thng tin chng ta bit, ting
Anh l prior information thng tin tin nh. V,
thng tin th ba l thng tin thc t, thut ng ting
Anh l likelihood. y, thng tin c ngha l
kh nng hay xc sut. Chng ta mun bit kh
nng bnh nhn tht s mc bnh. Do , 3 yu t
trn thng c gi l posterior probability, prior
probability, v likelihood, c th th hin qua cng
thc chung nh sau:
Xc sut hu nh = Xc sut tin nh + D liu thc t

Chng ta th xt qua 3 thng tin trong cng thc

trn mt cch chi tit hn nh sau:
Thng tin tin nh
Trc khi thc hin mt cng trnh nghin cu,
chng ta c vi nim v mc nh hng ca
mt liu php can thip. Trc khi c kt qu xt
nghim, chng ta thng bit kh nng mt c
nhn mc bnh cao c no. Nhng thng tin chng
ta bit trc nh th c gi l thng tin tin nh.
Trong phn tch v suy lun Bayes, c th ni thng
tin tin nh ng mt vai tr quan trng. Quan
trng l v kt qu phn tch c th thay i ty theo
cch chng ta cung cp thng tin tin nh. Quay li
hai trng hp t ra trn y, chng ta th xt qua
thng tin tin nh.
i vi trng hp 1, thng tin tin nh l kh
nng mc bnh. Kh nng ny c th l t l hin
hnh (prevalence) ung th v trong cng ng
thuc tui ca c nhn. Thng tin tin nh cng
THI S Y HC 07/2011 - S 62

c th l gi tr tin lng qua m hnh Gail.(3)

Chng hn nh i vi ph n 47 tui, khng c
tin s ung th v, khng c nhng yu t nguy c
khc, th s liu dch t hc cho bit t l hin hnh
ung th v l khong 1%. Do , chng ta c mt
thng tin tin nh: P = 0,01.
Thng tin tin nh trong trng hp 1 cn l
chnh xc ca phng php chp nh nh. Thng
thng, c hai ch s c th s dng phn nh
chnh xc ca mt phng php xt nghim:
nhy (sensitivity) v c hiu (specificity). Tht
ra, hai thut ng ting Anh ny khng hn thch
hp, nhng v gii y khoa s dng qu lu nn
chng ta tm chp nhn hai thut ng . Ti s
gii thch hai ch s ny nh sau:
nhy l xc sut c kt qu dng tnh nu
c nhn tht s mc bnh. Ni cch khc, nhy
tr li cu hi: nu 100 ngi mc bnh ung th v
u i chp nh nh th c bao nhiu ngi c kt
qu dng tnh. Nu phng php nh nh hon
ton chnh xc, chng ta k vng tt c 100 ngi
s c kt qu dng tnh. Nhng trong thc t,
khng c phng php no hon chnh, nn
nhy ca nh nh thng khong 90% hoc thp
hn (nhng chng ta s lc quan vi 90%).(4)
c hiu l xc sut c kt qu m tnh nu
c nhn tht s khng mc bnh. Thng thng
c hiu ca nh nh khong 80%. c hiu
80% c th hiu nh sau: nu 100 ngi khng mc
bnh u i chp nh nh th s c 80 ngi c kt
qu m tnh. Ni cch khc, s c 20 ngi c kt
qu dng tnh, v y l trng hp dng tnh
gi (false positive).
i vi trng hp 2, thng tin tin nh l s
phn b v nng glucose trong cng ng. Trong
trng hp 1, thng tin tin nh l t l hin hnh
mc bnh ung th v. Nhng trong trng hp 2,
thng tin tin nh l s phn b glucose trong cng
ng, nht l nhng ngi cng gii tnh v cng
tui. Hai thng s phn nh mt phn b l s
trung bnh v lch chun (hoc phng sai).
Nghin cu ca chng ti (cha cng b) trong
cng ng ngi Vit cho thy nam 60 tui, nng
glucose trung bnh l 105 mg/dL v phng sai
l 860 mg/dL2. C th hnh dung s phn b ca
glucose trong cng ng qua biu 1.
Mt thng tin tin nh khc l tin cy ca
phng php o lng glucose. Chng ta bit rng
nng glucose trong mu dao ng trong mi c
nhn ngay trong iu kin bnh thng (khng c
can thip sinh hc). Chng hn nh trng hp
31

Density

0.000

0.002 0.004 0.006 0.008 0.010

0.012

0.014

THNG K Y HC

50

100

150

200

Glucose (mg/dL

Biu 1: Phn b nng glucose trong cng ng nam

gii 60 tui, trung bnh 105 mg/dL v phng sai 860
2

mg/dL

bnh nhn c o glucose 5 ln lin tip trong 5

ngy, v kt qu nh sau (mg/dL): 127, 124, 125,
120, 126
Nu ch da vo kt qu ngy th nht v ngy
th nm, c nhn ny c phn vo nhm tiu
ng (v nng glucose cao hn hay bng 126
mg/dL). Nhng nu da vo kt qu ngy th hai,
th ba v th t th c nhn khng c chn on
tiu ng. y l mt tnh trng bt nh rt ph
bin trong lm sng v chn on. Khc vi s bt
nh trong chn on ung th v (khi chnh xc
c nh lng bng nhy, c hiu hay t l
dng tnh gi), s bt nh trong cc o lng
mang tnh lin tc (continuous variable) nh nng
glucose c nh lng bng h s tin cy m
thut ng ting Anh l coefficient of reliability.
H s tin cy cng ging nh h s tng quan
(coefficient of correlation). H s tng quan o
lng mc tng quan gia hai bin s. hiu h
s tin cy, chng ta cn n khi nim gi tr tht (true
values) v gi tr quan st (observed values hay
measured values). Chng hn trong trng hp trn,
chng ta khng bit nng glucose tht ca c nhn
l bao nhiu, m ch bit cc gi tr o c dao
ng trong khong 120 n 127 nmg/dL. Tuy khng
bit gi tr tht l bao nhiu, chng ta c th c tnh
t gi tr o lng c, v c lng s (estimate)
n gin nht l gi tr trung bnh. H s tin cy o
lng mc tng quan gia gi tr quan st c
v gi tr tht. H s tin cy dao ng t 0 (hon ton
khng tin cy) n 1 (tin cy tuyt i).
c tnh h s tin cy, ngi ta thng lm
nhng nghin cu ngn hn. Trong , mt nhm
32

c nhn c ly mu v o hn 2 ln (thng l 3
ln). T d liu , c th c tnh phng sai
(variance) nng glucose. Phng sai ny thc
cht gm c 2 thnh phn: phng sai do dao ng
trung bnh trong mi c nhn (vit tt l W) v
phng sai do dao ng gia cc cc nhn (B). H
s tin cy (vit tt l R) c tnh bng cch ly B
chia cho tng phng sai:
B
R
B W
H s tin cy v c bit l phng sai W l nhng
thng tin tin nh rt quan trng trong vic i n
mt chn on chnh xc v lu v di. Nghin cu
trc y ca chng ti cho thy phng sai W l 815
mg/dL2, v h s tin cy l 0.86.
Tm li, thng tin tin nh ca hai trng hp
c th tm lc trong bng s liu sau y:
Trng hp 1

Trng hp 2

V tn s mc
bnh hay phn b
trong cng ng

Tn s mc bnh
l 1%, hay P=0.01

chnh xc v
tin
cy
ca
phng php xt
nghim

nhy: 0.90
c hiu: 0.80
Dng tnh gi:
0.20

Phn b glucose
trong cng ng,
vi trung bnh 105
mg/dL v phng
sai 860 mg/dL2.
H s tin cy:
R=0.86
Phng sai trung
bnh trong mi c
nhn W = 815

Thng
nh

tin

tin

D liu thc t
D liu thc t, trong bi cnh hai trng hp
trn, l kt qu xt nghim.
i vi trng hp 1 (nghi ng ung th v), kt
qu xt nghim n gin l dng tnh.
i vi trng hp 2 (tiu ng) th d liu thc
t c th m t bng lut phn phi. Chng ta bit
rng nng glucose tun theo lut phn phi chun
(normal distribution). Lut phn phi chun, nh
cp trn, c xc nh bng hai thng s: trung bnh
v phng sai. Lut phn phi c th p dng m
t mt bin s cho mt nhm i tng hay cho mt
c nhn.
Trong trng hp 2, chng ta ch c mt kt qu xt
nghim glucose vi gi tr 127 mg/dL. Nhng chng ta
bit rng nu nng glucose ca c nhn ny c o
nhiu ln th chc chn nng khng phi l 127
nhng c th dao ng theo lut phn phi chun. Do
, chng ta c th pht biu rng i vi c nhn 2,
nng glucose tun theo lut phn phi chun vi
trung bnh 127 mg/dL v phng sai 815 mg/dL2 (da
vo thng tin tin nh). Cc gi tr glucose ca c nhn
ny c th th hin bng biu 2.
THI S Y HC 07/2011 - S 62

0.000 0.002 0.004 0.006 0.008 0.010 0.012 0.014

Thng tin hu nh
Da vo hai thng tin tin nh v d liu thc
t, chng ta c th tr li cu hi t ra lc ban u.
Phng php c thng tin hu nh l ng dng
nh l Bayes nh m t trong phn u.
i vi trng hp 1, cn nhc li rng chng ta
mun bit xc sut bnh nhn mc bnh ung th v
l bao nhiu sau khi c kt qu dng tnh t
nh nh. hiu cng thc 1 ti s gii thch bng
cch gi nh rng chng ta c mt qun th gm
1000 ph n trong tui 47. Chng ta bit rng
(qua thng tin tin nh) trong s 1000 ngi s c
10 ngi mc bnh ung th v, v do 990 ngi
khng mc bnh.
Cng qua thng tin tin nh, chng ta bit rng
nhy l 90%. Do , trong s 10 ngi mc
bnh, s c 9 ngi (10 x 0,90) c kt qu dng
tnh (v 1 ngi c kt qu m tnh).
Ngoi ra, v c hiu l 80%. Do , trong s
990 ngi khng mc bnh, s c 792 ngi (990 x
0,80) c kt qu m tnh (v 198 ngi c kt qu
dng tnh - y tht ra l dng tnh gi).
Nh vy, tng cng chng ta c 9 + 198 = 207
ngi c kt qu dng tnh. Tuy nhin, trong s
ny, ch c 9 ngi tht s mc bnh ung th v,
cn 198 ngi khng mc bnh (v do t l dng
tnh gi). Do , xc sut m ngi ph n mc
bnh ung th v vi iu kin c kt qu dng
tnh l: 9 / 207 = 4,3%.
Tht ra, c th c tnh da vo cng thc (1)
mt cch nhanh gn hn. Gi nhy l P(D | H);
xc sut dng tnh gi l P(D | NoH), NoH l
khng mc bnh; v t l hin hnh l P(H), xc
sut mc bnh vi kt qu dng tnh l:
P H P D | H
P H | D
PH PD | H 1 P H PD | NoH
0.01 0.90
P H | D
0.043
0.01 0.90 0.10 0.2

Density

THNG K Y HC

50

200

250

Biu 2: Phn b nng glucose ca mt c nhn 60

2
tui, trung bnh 127 mg/dL v phng sai 815 mg/dL

phn ln bc s hiu lm rng nhy l xc sut

mc bnh, nn nhiu bc s cho rng xc sut mc
bnh l 90%. Nhng cch din gii sai. Sai lm
l v c s nhm ln gia hai xc sut. Gi H l
bnh ung th v D l kt qu xt nghim dng
tnh, nhy c nh ngha l: P(D | H)
Cn xc sut mc bnh vi iu kin c kt qu
dng tnh l: P(H | D)
Tuy cch vit ch khc nhau v th t ca H v
D, nhng ngha th rt khc nhau! nhy phn
nh chnh xc ca phng php nh nh ch
khng ni ln xc sut mc bnh ung th v.
Trong trng hp 2, cu hi v thng tin hu
nh c phn khc hn trng hp 1. Chng ta
mun bit vi kt qu xt nghim glucose trong
mu l 127 mg/dL, xc sut m c nhn mc bnh
tiu ng l bao nhiu. V 126 mg/dL l ngng
chn on tiu ng, nn cu hi c th vit
bng ngn ng xc sut nh sau:
P(glucose > 126) = ?
tr li cu hi , chng ta cn xc nh lut
phn phi ca glucose cho c nhn. Gi s trung bnh
v lch chun ca glucose trong cng ng ln lt
l mprior v sprior. Tng t, gi s trung bnh v
lch chun ca glucose ca c nhn l mdata v sdata.
Qua vi php tnh, c th chng minh rng glucose
trung bnh v lch chun ca c nhn l:

m posterior

THI S Y HC 07/2011 - S 62

150

Glucose (mg/dL

m prior

C l nhiu ngi s ngc nhin ti sao xc sut

mc bnh thp. Nhng y, cn ni thm rng

100

mdata
2
s 2prior
sdata

1
1

2
s 2prior sdata

33

THNG K Y HC

m posterior

105 127

860
815 = 116

1
1

860 815

s posterior

0.015
0.010

200

tui, trung bnh 116 mg/dL v lch chun 20.5 mg/dL.

glu cos e116 2

f glucose = 0,312

Ni cch khc, mc d nng glucose ca c

nhn ny nm trong ngng chn on tiu ng
(127 mg/dL), nhng v bit c tin cy ca
phng php xt nghim v thng tin tin nh
trong cng ng, xc sut m bnh nhn c nng
glucose trn 126 mg/dL tht ra ch 31,2%, cha
thuyt phc chn on c nhn ny mc bnh
tiu ng. Chi tit v l thuyt v cch ng dng
c th xem qua vi nghin cu trc ca ngi vit
bi ny(5,6) v ng nghip khc.(7-10)
34

150

Biu 3: Phn b nng glucose ca mt c nhn 60

2
1
f glucose
e 220.5
20.5 2
Xc sut trn chnh l din tch di ng biu
din ca hm s glucose cho c nhn . Theo :

126

100
Glucose (mg/dL

1
1

860 815
Ni cch khc, nng glucose trung bnh v
lu v di (hay nng tht) ca c nhn l 116
mg/dL, nhng c th dao ng trong khong 75.8
n 156.2 mg/dL vi xc sut 95% (tc 116
1.9620.5 n 116+1.9620.5). C th hnh dung
phn b glucose ca c nhn ny nh Biu 3.
Nhng chng ta mun bit P(glucose > 126).
Bi v nng glucose tun theo lut phn phi
chun vi trung bnh 116 mg/dL v lch chun
20,5 mg/dL, nn c th m t bng cng thc sau
y:

0.005

50

= 20.5

P glucose 126

0.000

2 21
s

prior s data
Quay li trng hp 2, xin nhc li, chng ta bit
rng trong cng ng, nng glucose tun theo
lut phn phi chun vi trung bnh 105 mg/dL v
phng sai 860 mg/dL2. Chng ta cng bit nng
glucose ca c nhn tun theo lut phn phi
chun vi trung bnh 127 mg/dL v phng sai 815
mg/dL2. T hai thng tin ny, chng ta c th xc
nh phn phi glucose ca c nhn sau khi iu
chnh vi thng tin tin nh.

0.020

Density

s posterior

Din tch di ng biu din (mu ) l xc sut c

nhn c nng glucose cao hn 126 mg/dL (tc c
th chn on tiu ng)

Suy lun Bayes

Phng php phn tch thng k ng vai tr rt
quan trng trong nghin cu y khoa, c bit l
nghin cu lm sng. Khng c thng k, nghin
cu lm sng ch l nhng con s v hn v khng
c gi tr khoa hc. Trong thi gian khong 100
nm qua, khoa hc thng k pht trin c rt
nhiu phng php phn tch c th ng dng cho
rt nhiu tnh hung khc nhau trong nghin cu y
hc. Nhng phng php ny da vo trit l phn
nghim (falsificationism), m theo nh nghin
cu tin hnh 3 bc.
Bc th nht, pht biu gi thuyt v hiu H0;
Bc th hai, thu thp d liu D; v
Bc th ba, c tnh xc sut D xy ra nu
H0 l tht: P(D | H0).
l qui trnh chng minh o ngc (proof by
contradiction) hay cn gi l phn chng. Qui trnh
ny c th p dng trong ton hc, nhng khi ng
dng vo y hc th tr nn v duyn. Trong y khoa
chng ta mun bit vi d liu thu thp c, xc sut
gi thuyt H0 tht l bao nhiu, ch khng ai li t
cu hi nu gi thuyt H0 l ng th xc sut D xy ra
l bao nhiu! Tng t, khng ai ng ngn hi nu ti
mc bnh th xc sut kt qu xt nghim dng tnh
l bao nhiu (v nu mc bnh th phi iu tr, ch
khng hi nh th). Ngi ta hi: nu kt qu xt
nghim l dng tnh, kh nng ti mc bnh l bao
THI S Y HC 07/2011 - S 62

THNG K Y HC

nhiu, ln k hoch i ph. Phng php phn

tch c in khng th tr li cu hi ny (m ch tr
li cu hi o ngc).
Trong y khoa, bt nh l qui lut ch khng phi
l iu bt bnh thng. x l s bt nh, chng
ta cn mt phng php phn tch v suy lun logic.
V mt nh gi bng chng trong iu kin bt
nh, ch c phng php Bayes l phng php
logic nht. C th ni rng phng php suy lun
Bayes khng phi xa l g vi bc s lm sng. Theo
Bayes, kin thc chng ta tip thu qua kin thc
bit v d liu thc t. Tng t, trong chn on
bnh, xc sut mc bnh ty thuc vo thng tin lin
quan n c nhn v kt qu xt nghim. Nu hai c
nhn c nhng yu t nguy c ging nhau, nhng c
nhn c kt qu dng tnh s c kh nng mc bnh
cao hn so vi c nhn c kt qu m tnh. Nhn theo
gc ny, suy lun Bayes chnh l mt phng
php c nhn ha trong nh lng lm sng v chn
on bnh. Do , phng php suy lun Bayes rt
thch hp cho cc nh lm sng.
Tm li, suy lun Bayes l mt phng php suy
lun da vo thng tin chng ta thu thp trc
y cng vi d liu thc t c c tri thc mi
hon chnh hn. C th ni l mt qui trnh suy
lun tch ly. Tri thc khoa hc l tri thc c tch
ly theo thi gian, v phng php Bayes cung cp
cho chng ta mt phng tin rt c ch cho s pht
trin khoa hc.
Quay li hai trng hp nu ra trong phn u bi
vit. i vi trng hp 1, chng ta c th tr li
rng kt qu nh nh l dng tnh, v l mt kt
qu ng quan tm, nhng cn phi din gii trong
iu kin bt nh ca phng php chp nh nh.
C 100 ngi c kt qu dng tnh, th c khong 4
ngi tht s b ung th v, nhng bc s khng th
chc chn rng c nhn ny s mc bnh. Xc sut
4% c l thp, nhng vn th hin cao gp 4 ln so
vi mt ngi ph n trung bnh cng tui. Tht
ra, trong thc t, kt qu nh nh ch l mt bc (c
th quan trng) trong qui trnh chn on v xt
nghim xc nh kh nng mc bnh.
i vi trng hp 2, mc d kt qu xt
nghim cho thy nng glucose trong mu l 127
(tc ngng tiu ng), nhng v phng php xt

THI S Y HC 07/2011 - S 62

nghim c tin cy cha cao, nn kt qu t n

cng mang tnh bt nh. Sau khi xem xt dao
ng trong mi c nhn v kt hp vi thng tin
trong cng ng, c th ni rng kh nng c nhn
ny tht s b tiu ng ch 31%, thp hn ngng
95% kh xa. Trc kt qu v nh gi ny, c l
mt xt nghim khc trong mt thi im khc s
cung cp thng tin chc chn hn.
Phng php suy lun v phn tch da vo
trng phi Bayes v ang tr nn ph bin
trong nghin cu y khoa. Ngy nay, hu nh bt c
lnh vc nghin cu no nht l chn on u
cn n phng php Bayes. Trong tnh trng bt
nh o lng, ngay c vi nhng phng php o
lng c chnh xc cao, suy lun Bayes chng t
l mt phng tin rt c ch. Hi vng rng bi ny
cung cp cho bn c vi nim v cch ng
dng phng php suy lun Bayes trong chn on
lm sng.
Ti liu tham kho
(1) Osler W. Trch trong Clinical ethics: a practical approach to ethical
decisions in clinical medicine (trang 17) ca Albert R. Jonsen v cs. Nh
xut bn McGraw-Hill Professional 2002.
(2) Bayes, Thomas; Price, Mr. (1763). An Essay towards solving a Problem
in the Doctrine of Chances. Philosophical Transactions of the Royal
Society of London 53 (0): 370418. C th xem bn gc ca bi bo
quan trng ny ti a ch:
http://www.stat.rice.edu/~blairc/seminar/Files/danTalk.pdf
(3) Gail MH, Brinton LA, Byar DP, Corle DK, Green SB, Chairer C, Mulvihill
JJ, Projecting individualized probabilities of developing breast cancer for
white females who are being examined annually. J Natl Cancer Inst
1989; 81:1879-1886.
(4) Eddy, D. M. (1982). Probabilistic reasoning in clinical medicine:
Problems and opportunities. In D. Kahneman, P. Slovic & A. Tversky
(Eds.), Judgment under uncertainty: Heuristics and biases (pp. 249267). Cambridge, England: Cambridge University Press.
(5) Nguyen TV, et al. Within-subject variability and analytic imprecision of
insulinlike growth factor axis and collagen markers: implications for
clinical diagnosis and doping tests. Clin Chem 2008;54:1268 76.
(6) Nguyen TV, Pocock NA, Eisman JA. On the interpretation of bone
mineral density measurements and its change. Special Article: J Clin
Densitometry 2000; 3:107-19.
(7) Dunson DB. Commentary: Practical Advantages of Bayesian Analysis of
Epidemiologic Data. Am J Epidemiol 2001;153:12226.
(8) Spiegelhalter DJ, Myles JP, Jones DR, et al. An introduction to Bayesian
methods in health technology assessment. BMJ 1999;319:50812.
(9) Lilford RJ, Braunholtz D. Whos afraid of Thomas Bayes? J Epidemiol
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