mtkicebiTi medicina-epidemiologiuri gaTvlebi

VI kursi
hendauti studentebisaTvis

mt ki c ebi T i med i c i ni s s akvanZo

ko nc ef c i ebi an 4 nabi j i
mt ki c ebi T med i c i naSi

“epi d emi o l o gi ur i gaT vl ebi ”

mo d u l i s d amT avr ebi s Semd eg

s t u d ent a u nd a i c o d es :
• mt ki c ebi T i med i c i ni s 4 Zi r i T ad i nabi j i
• r o go r d as vas mkaf i o kl i ni ku r i Seki T xva
• r o go r mo i Zi o s u axl es i l i t er at u r a
• Ses Zl o s kvl evi s s xvad as xva d i z ai ni s d axas i aT eba
• d aaxas i aT o s s i s t emu r i d a ko nt r o l i r ebad i
r and o mi z i r ebu l i kvl evebi s mni Svnel o vani as peqt ebi
• er kveo d es met a- a-anal i z Si gamo yenebu l Zi r i T ad
s t at i s t i ku r meT o d i kaSi
• Ses Zl o s d amo u ki d ebl ad awar mo o s epi d emi o l o gi u r i
gaT vl ebi
• gans az Rvr o s d i agno s t i ku r i d a s kr i ni ngu l i t es t ebi s
s t at i s t i ku r i maxas i aT ebl ebi d a gai go s , r o go r
gamo i yeneno s i s i ni kl i ni ku r pr aqt i kaSi
 r a ar i s mt ki c ebi T i med i c i na?
 “… pac i ent ebi s aTvi s i nd i vi d ual ur i
s amed i c i no d axmar ebi s gawevi s as
gad awyvet i l ebi s mi Rebi s pr o c es Si s aukeTes o ,
Tanamed r o ve d amt ki c ebu l i f aqt ebi s
gaaz r ebu l i , Segnebul i d a d awvr i l ebi Ti
gamo yeneba”
 “...…
mt ki c ebi Ti med i c i ni s pr aqt i ka ni Snavs
i nd i vi d ual ur i kl i ni kur i gamo c d i l ebi s a
d a c o d ni s i nt egr ac i as s i s t emur i kvl evebi s
Sed egad mi Rebul yvel az e s ar wmuno
kl i ni kur mo nac emebTan”
BMJ 1996; 312: 71-2

 Sackettis mier 2000wels SemoTavazebuli iqna mtkicebiTi medicinis aseTi ganmarteba:

mtkicebiTi medicina aris yvelaze sarwmuno samecniero mtkicebulebebis, klinikuri
codnisa da gamocdilebisa da pacientis faseulobaTa sistemis integrireba. SesaZlebelia
dominirebdes romelime erT-erTi rgoli , magram umjobesia samive rgolis tolad
monawileoba. garegan klinikur mtkicebulebebs ZaluZT mxolod informireba da ara
klinikuri gamocdilebis Canacvleba. swored am gamocdilebis xarjze unda gadawydes
exeba Tu ara garegani mtkicebuleba mocemul konkrertul pacients da rogor unda moxdes
misi integrireba saboloo klinikur gadawyvetilebaSi.
 sarwmuno samecniero mtkicebulebebi warmoadgens klinikurad relevantur
mtkicebulebebs. gamoyenebuli diagnostikuri testebi unda iyos zusti, prognosturi
markerebi unda iyos mZlavri, rekomendirebuli Carevebi unda iyos usafrTxo da efeqturi.
 klinikuri gamocdileba warmoadgens klinicistis mier sakuTari klinikuri unar-Cvevebis
gamoyenebis unars pacientis janmrTelobis dazustebis, konkretuli pacientis mimarT
nebismieri potencialuri Carevis riskebisa da sargeblis diagnostirebis mizniT.
 pacientis faseulobaTa sistema moicavs pacientis unikalur moTxovnilebebs, pacientis
molodins, SiSebs, romliTac is midis eqimTan da klinikuri gadawyvetilebis miRebisas
isini gaTvaliswinebul unda iqnas.

mt ki c ebi T i med i c i ni s mi z ani

gamo qveynebu l i kl i ni ku r i mt ki c ebi T i med i c i ni s Ri r ebu l eba

kvl evebi s r ez u l t at ebi s
i nt er pr at ac i i s a d a gamo yenebi s
gz i T s amed i c i no xar i s xi s
gau mj o bes eba
• s amed i c i no mt ki c ebu l ebebi mu d mi vad c val ebad o bs
• mt ki c ebi T i med i c i na gvaZl evs kvl evaT a Sed egebi s
i nt er pr et i r ebi s a d a i mi s ganWvr et i s s aSu al ebas ,
Sevc val o T T u ar a Cveni pr aqt i ka
• mt ki c ebi T i med i c i na gvaZl evs i ns t r u ment s mT el i
c xo vr ebi s manZi l z e u wyvet i ganaT l ebi s
ganxo r c i el ebi s aT vi s
• mt ki c ebi T i med i c i ni s s wavl eba Ses aZl ebel i a kl i ni ku r
T emas T an er T ad

• samedicino xarisxis gaumjobesebis mizniT eqims sWirdeba samecniero mtkicebulebebi

diagnostikuri da skrininguli testebis sizustis, mkurnalobis meTodebisa da intervenciebis
efeqturobisa da usafrTxoebis Sesaxeb. maRali xarisxis jandacviTi momsaxureba
gulisxmobs praqtikas, romelic mudmivad efuZneba mxolod sarwmuno klinikur
monacemebs. eqimebi klinikuri gadawyvetilebis dros unda iyenebdnen arsebul
mtkicebulebebs, manamde sanam maT gankargulebaSi ar iqneba axali, ufro sarwmuno
mtkicebulebebi. literaturis moZieba, monacemTa analizi mTeli praqtikuli moRvaweobis
ganmavlobaSi eqims mudmivad amyofebs Tanamedrove samedicini literaturis kursSi.
 mt ki c ebi T med i c i ni s o T xi nabi j i

• d as vi T mkaf i o kl i ni ku r i Seki T xva ,

r o mel z ec gs u r T pas u xi s mi Reba
• ki T xvaz e pas u xi s gas ac emad mo i Zi eT
u axl es i s au keT es o mt ki c ebu l ebebi
• kr i t i ku l ad Seaf as eT mo Zi ebu l i
Mmt ki c ebu l ebebi s s ar wmu no eba
• mo xd i neT mt ki c ebu l ebi s i nt egr i r eba
pac i ent i s i nt er es ebT an, ko nkr et u l
gar emo ebebT an d a kl i ni ku r
gamo c d i l ebas T an d a Seaf as eT ,
Ses aZl ebel i i qneba T u ar a aRni Su l i
t eqno l o gi i s d aner gva

mtkicbiTi medicinis 4 nabiji: SekiTxvis formulireba, saukeTeso damtkicebuli faqtebis moZieba,

moZiebuli faqtebis Sefaseba da moZiebuli faqtebis safuZvelze klinikuri gadawyvetilebis
miReba.

Seki T xvi s f o r mu l i r ebi s magal i T i

1)kl i nku r i Seki T xvi s s wo r i P ICO-s mi xed vi T :
f o r mu l i r eba P ICO-s mi xed vi T :
• amc i r ebs o r s u l o bi s 12 kvi r amd e
axal gaz r d a j anmr T el i po pu l ac i a - o r s u l ebi s aT vi s f o l i u mi s mJavi s
qal i s aT vi s , r o mel s ac
s u r s ko nt r ac epc i i s Populacion 4mg-i s mi Reba ner vu l i Rer o s
gamo yeneba, mat u l o bs
Car eva – d ef eqt i s ganvi T ar ebas i m
ki bo s ganvi T ar ebi s r i s ki
o r al u r i ko nt r ac epc i i s Intervention o r s u l ebT an Sed ar ebi T , r o ml ebmac
gamo yenebi s SemT xvevaSi Sed ar eba- ar gamo i yenes f o l i u mi s mJava
ko nt r ac ept i u l i t abl e-
Comparison
t ebi s ar gamo yenebas T an
Sed ar ebi T ?
gamo s aval i -
Outcome

SekiTxvis formulireba moicavs (PICO):

1. pacients an populacias
2. Carevas anu eqspozicias
3. Carevis Sedarebas anu sakontrolo jgufs
4. gamosavals
SekiTxvis formulirebis magaliTi: 22 –wlis qali movida eqimTan ojaxis dagegmarebis
sakiTxebze konsultirebis mizniT, mas unda efeqturi Casaxvis sawinaaRmdego saSualebis
gamoyeneba, magram eSinia hormonaluri kontraceptivebis gverdiTi movlenebis. is eqims
usvams SekiTxvas, xom ar izrdeba kibos ganviTarebis riski hormonaluri kontracepciis
gamoyenebis dros:

2) T anamed r o ve s au keT es o s ar wmu no

mt ki c ebu l ebebi s mo Zi eba.
• s aku T ar i Zal ebi T mt ki c ebu l ebebi s mo Zi -
eba s xvad as xva i nt er net mi s amar T ebi T -
MEDLINE,PUBMEDI d a s xv.
• eqs per t ebi s mi er Sed geni l i mt ki c ebi T i
med i c i ni s r ez u meebi s gamo yeneba ( j anmo ,
ko xr ani s bi bl i o T eka, enki ni s wi gni )
• eqs per t ebi s mi er Sed geni l i mt ki c ebi T i
med i c i ni s pr o t o ko l ebi s gamo yeneba
 • rogor gamovavlinoT iseTi samecniero statiebi, romelic upasuxebs garkveul klinikur
SekiTxvas? adre Zalze Zneli iyo sarwmuno mtkicebulebebis moZieba.
saxelmZRvaneloebi Tavisi gamocemis momentisaTvis moZvelebuli xdeba, samedicino
literatura Zalzed mravalricxovania, arasistemuri da araobieqturia. saTanado informaciis
moZiebis mizniT eqimma dRiurad unda waikiTxos 19 samecniero statia, raTa gaecnos
wliurad gamocemul 6000 statias. aRsaniSnavia, rom statiaTa 95% ar pasuxobs xarisxis
minimalur standartebs da klinikur adeqvaturobas. imisaTvis rom moviZioT samecniero
mtkicebulebebi aucilebelia literaturis Ziebis efeqturi strategiebis floba, aseve Jurnalis
statiebis xelmisawvdomoba, sxvadasxva kvlevebis dizainis garkveva da imis gageba,
rom “saukeTeso dizaini” damokidebulia klinikur SekiTxvaze.
sarwmuno informaciis moZiebisaTvis arsebobs sami gza:
1.sakuTari ZalebiT mtkicebiT medicinasTan mierTeba sxvadasxva internet misamarTebiT-
MEDLINE,PUBMEDI da sxv;
2. sxvebis mier Sedgenili mtkicebiTi medicinis rezumeebis gamoyeneba ( janmo-s, koxranis da
sxv. biblioTeka, enkinis wigni da sxv.);
3. sxvebis mier Sedgenili mtkicebiTi medicinis protokolebis gamoyeneba.

kvl evaT a d i z ai nebi s i er ar xi a

Experimental
Studies: CAN be RCT
the gold standard Highest
internal
Observational validity at
studies: top
More prone to
bias and
confounding

kvl evi s s au keT es o d i z ai ni

• kvl evi s s au keT es o d i z ai ni

d amo ki d ebu l i a d as mu l Seki T xvaz e:
mkur nal o bi s an Car evi s
ef eqt ur o ba- r kk an met a-anal i z i
d aavad ebi s mi md i nar eo ba-
ko ho r t u l i kvl eva
r i s k-f aqt o r ebi - ko ho r t u l i an
SemT xveva-ko nt r o l i kvl eva

rogor CavataroT konkretul problemaze statiebis SedarebiTi Sefaseba? klinikuri kvlevebi

gansxvavdeba dizainisa da miRebuli rezultatebis sarwmunoebiT. sarwmunoebis yvelaze maRali
done axasiaTebs sistemuri mimoxilvebsa da randomizirebuli klinikuri kvlevebis meta-analizs,
Semdgom safexurze imyofeba randomizirebuli klinikuri kvlevebi. im SemTxvevaSi, Tu
problemasTan mimarTebaSi randoizirebuli kvleva Catarebuli ar aris, unda moZiebul iqnas
mtkicebiTi TvalsazrisiT Semdegi saukeTeso mtkicebulebebi. mtkicebulebebis Semdeg safexurze
dgas kohortuli kvlevebis Sedegad miRebuli mtkicebulebebi. kohorta aris erTi saerTo niSniT
gaerTianebul adamianTa jgufi, romlebzec dakvirveba grZeldeba garkveuli drois ganmavlobaSi,
raTa dadgindes, ra moxdeba SemdgomSi. xolo kohortuli kvleva, es iseTi kvlevaa, sadac
pacients gaaCnia garkveuli daavadeba da/an Rebulobs garkveul mkurnalobas, masze dakvirveba
mimdinareobs garkveuli periodis ganmavlobaSi da Sedareba xdeba im jgufTan, romelsac
eqsperimentaluri mkurnaloba ar utardeboda. sarwmunoebis mixedviT Semdgom safexurze
imyofeba kvlevis dizaini- SemTxveva-kontroli, retrospeqtuli kvleva, romelSic pacientebs ukve
aqvT konkretuli daavadeba da Sedareba xdeba am daavadebis ar mqone sakontrolo jgufTan.
kvlevis es dizaini miekuTvneba obzervaciul tipis kvlevebs. masze dabal safexurze dgas aseve
obzervaciuli tipis kvleva - klinikur SemTxvevaTa seria, romelTa monacemebis safuZvelze
miRebuli rekomendaciebi C donisaa. aseTi tipis kvlevebSi ar aris sakontrolo anu Sedarebis
jgufebi. klinikur kvlevebs, romelSic mkvlevari monacemebs agrovebs bunebrivad mimdinare
SemTxvevaze dakvirvebis gziT da ara am procesebSi aqtiurad CareviT, ewodeba obzervaciuli
kvlevebi. am tipis kvlevebs miekuTvneba riskis dasadgeni kvlevebis umravlesoba-kohortuli,
SemTxveva-kontroli da sxv.

MODELLI DI SPERIMENTAZIONE
r at o m r and o mi z i r ebu l i kvl evebi ?
STUDIO CLINICO CONTROLLATO RANDOMIZZATO
• kl i ni ku r i kvl evebi s aT vi s f aqt ebi s
mt ki c ebu l ebi s yvel az e maRal i
d o ne e.w.”
e.w.”o qr o s s t and ar t i ”
• s au keT es o t es t i a i nt er venc i i s
xar i s xi s Ses af as ebl ad
• pac i ent ebi d ayo f i l i a
eqs per i ment al u r d a s ako nt r o l o
j gu f ebad , r ac j gu f ebs xd i s
ko mpar abel u r s

G. Gori

mkurnalobis efeqturobis Sefaseba SesaZlebelia ganxorcieldes obzervaciuli kvlevebiT da

eqsperimentuli( klinikuri kvlevebiT). randomizirebuli kvleva, gansakuTrebiT ki ramdenime
maTganis sistemuri mimoxilva, imdenad informatiulia, xolo Secdomis albaToba imdenad
mcirea, rom igi iqca e.w. oqros standartad”, romelic saSualebas gvaZlevs vimsjeloT, moaqvs Tu
ara mocemul mkurnalobas zianTan SedarebiT ufro meti sikeTe. amgvarad, kontrolirebadi
randomizirebuli kvlevebi warmoadgens mkurnalobis efeqturobis samecniero kvlevebis xarisxis
standarts. Tavdapirvelad irCeven Sesaswavli mdgomareobis mqone pacientTa did jgufs,
romelTac Semdgom SemTxveviTi gziT yofen or jgufad, eqsperimentulad da sakontrolod. orive
jgufis pacientebi imyofebian erTsa da igive pirobebSi, gansxvaveba mxolod Catarebuli Carevis
saxeobaSia. kvlevis aseTi ageba Tavidan gvacilebs sistemur Secdomas. randomizaciis garda
sistemuri Secdomebis minimizaciis saSualebas warmoadgens kvlevis dabrmaveba.

Clinical Epidemiology ,The essentials, Robert H.Fletcher, 1998

 r at o m ar i s r and o mi z i r ebu l i
kvl evebi Zal i an s ar wmu no ?

• r and o mi z ac i a
• d abr maveba
• mku r nal o bi s d ani Snu l meT o d z e
d amo ki d ebu l i anal i z i
• Losses to follow-up

randomizacia- avadmyofis ama Tu im gamosakvlev jgufSi SemTxveviT mikuTvnebis meTodi.

pacientebis gadanawileba jgufebSi xdeba ise, rom TiToeul pacients gaaCnia erTnairi Sansi
moxvdes rogorc sakontrolo, ise eqsperimentul jgufSi. randoizacia aTanabrebs pacientze moqmed
im faqtorebs, romlebsac SeuZliat gavlena iqonion prognozze. sistemuri Secdomis minimizaciis
erT-erTi meTodi mdgomareobs brma kvlevis gamoyenebaSi (blinding) anu SeniRbvaSi. brma
meTodi SesaZlebelia ganxorcieldes oTx doneze (gamnawilebeli, pacienti, damkvirvebeli eqimi,
monaceebis Semfasebeli).
kontrolirebadi randomizirebuli kvlevebis rezultatebis analizi SesaZlebelia ganxorcieldes ori
xerxiT: an randomizaciis procesSi daniSnuli mkurnalobis faqtis safuZvelze an pacientis mier
faqtiurad
ganxorcielebuli mkurnalobis safuZvelze. mkurnalobis ufro upiratesi meTodis gamoyenebis
Sesaxeb klinikuri gadawyvwtilebis miRebisas, unda gamoyenebul iqnas analizi, romelic
efuZneba randomizaciis procesSi daniSnul mkurnalobas. aseT midgomas mkurnalobis daniSnul
meTodze damokidebuli analizi hqvia (intention to treat analysis). Tu analizi efuZneba im
mkurnalobas, romelsac avadmyofi sinamdvileSi. e.i. Seiswavleba im mkurnalobis efeqturoba,
romelic randomizaciis procesSi ar iyo daniSnuli da maSin kvleva aRar aris randomizirebuli,
aramed xdeba Cveulebrivi kohortuli kvleva.

Clinical Epidemiology ,The essentials, Robert H.Fletcher, 1998

s i s t emu r i kvl eva

Mmet a-anal i z i d a s i s t emu r i mi mo xi l va
• ko nkr et u l kl i ni ku r Seki T xvaz e
s au keT es o pas u xi s mo Zi ebi s mi z ni T ad r e
Cat ar ebu l i kvl evebi s s i s t emu r i d a s amec ni er o kvl evebi
kr i t i ku l i Sef as eba
4
• kvl evaT a s i nT ez i r eba Ses aZl ebel i a: a: 1 2 3

 xar i s xo br i vad
 r ao d eno br i vad (met a- a-anal i z i )
• z r d i s s t at i s t i ku r s i mZl avr es
• gamo avl ens kvl evaT a So r i s po t enc i u r Mmet a-
a-anal i z i

s xvao bas ko mbi ni r ebu l i r ez u l t at ebi

State University of New York, USA, 2002

• samedicino literaturis sistemuri kvlevebi warmoadgens samecniero mtkicebulebebis

Sejamebas. sistemuri kvlevebi eZRvneba mkurnalobis, etiologiis, diagnozisa da
 prognozis sakiTxebs da exmareba klinicistebs mkurnalobis optimaluri meTodis
SerCevaSi. sistemuri kvlevis erT-erTi upiratesoba mdgomareobs imaSi, rom masSi
gaerTianebulia bevri mcirericxovani kvleva, romelic calcalke aRebuli arasakmarisia
sarwmuno rezultatebis misaRebad, xolo gaerTianebis Sedegad miRebuli rezultatebi
Zalzed sarwmunoa, radganac miRebulia gaerTianebul mravalricxovani pacientebis
kvlevis Sedegad.

Clinical Epidemiology ,The essentials, Robert H.Fletcher, 1998

met a-anal i z i Профилактика преждевременных родов

кортикостероидами:
кортикостероидами:
• er T i d a i gi ve Car evi s r amd eni me синдром острой дыхательной недостаточности
kl i ni ku r i kvl evi s gaer T i anebu l i
Sed egi s r ao d eno br i vi anal i z i .
• z r d i s s t at i s t i ku r s i mZl avr es
• gamo i yeneba :
 mr aval i kl i ni ku r i kvl evi s Sed egebi s
ganz o gad o ebu l i war mo d geni s aT vi s
 kvl evaT a Sed egebi s mt ki c ebi T i
Ri r ebu l ebi s gaz r d i s aT vi s

Zalze mniSvnelovania problemis Sesaxeb publikaciebis ganzogadeba, romlisTvisac

formalizebuli meTodebi gamoiyeneba. formalizebuli meTodebiT garkveul sakiTxze arsebul
kvlevaTa ganzogadebis process meta-analizi anu analizis analizi anu informaciis sinTezi
ewodeba. aseTi midgoma gansakuTrebiT Rirebulia, roca ganixileba erTi konkretuli sakiTxi da
arsebobs ramdenime sarwmuno, magram gansxvavebuli maCvenebeli. meta- analizi ajamebs
pirveladi kvlevebis raodenobriv rezultatebs. meta-analizis rezultatebi warmodgenilia specialur
grafikze, romelzec mocemulia, rogorc calkeuli kvlevis rezultatebi, aseve efeqtis erTiani
ganzogadebuli maCvenebeli. samkurnalo efeqtis zusti dadasturebis mizniT saWiroa bevri
pacientis gamokvleva, amitom mkvlevarTa umravlesoba upiratesobas aniWebs kvlevebis
Sedegebis Sefasebas meta-analizis gziT, romelic erTad krebs mravali sarwmuno kvlevis
monacemebs. mtkicebiTi medicinis mniSvnelovan elementis warmoadgens, eqimebisaTvis
kvlevaTa monacemTa gardaqmna naTel, mkafio rekomendaciebad. moqmedeben
rekomendaciebi eqimTa qcevebze. 59kvlevis meta-analizma aCvena, rom 90% SemTxvevaSi
klinikurma rekomendaciebma Secvala klinikuri praqtikebi da aumjobesebs mkurnalobis
rezultatebs.
Clinical Epidemiology ,The essentials, Robert H.Fletcher, 1998
 K3) mt ki c ebu l ebebi s kr i t i ku l i Sef as eba
Zi r i T ad i bi o s t at i s t i ka

• SemTxvevi s s i xSi r eEvent rate(EER and CER)

• r i s kT a Tanaf ar d o ba anu f ar d o bi Ti
r i s ki (RR)
• f ar d o bi Ti r i s ki s d aqvei Teba (RRR)
• abs o l ut ur i r i s ki s d aqvei Teba (ARR)
• avad myo f Ta r ao d eno ba r o mel i c
s aWi r o ebs mkur nal o bas (NNT)
• r i s kebi d a Sans ebi

statiis gamovlenis Semdeg aucilebelia Sefasdes warmodgenili monacemebis xarisxi.

imisaTvis, rom warmodgena gvqondes, Tu rogoria mkurnalobis efeqturoba da rogor gavuziaroT
es informacia danarCenebs, aucilebelia kvlevis rezultatebi gamovxatoT sxvadasxva meTodebiT.
anu sxvagvarad rom vTqvaT, rogor gamoviyenoT mtkicebiTi medicinis mier mopovebuli
informacia klinikur praqtikaSi da rogor ganvaxorcieloT statiis kritikuli analizi. unda vicodeT, Tu
rogor izomeba gamosavali, rezultatebi ise unda iyos warmodgenili, rom gamoxatavdnen maT
praqtikul Rirebulebas. mkurnalobis efeqturobis Sefasebis aRqmaze gavlenas axdens rezultatebis
interpretirebis, mowodebis meTodebi. rezultatebi, romlebic gamoxatulia fardobiTi riskis
saSualebiT , ufro mniSvnelovnad gveCveneba, vidre igive rezultatebi gamoxatuli damatebiTi
riskis an NNT-is saSualebiT.

Clinical Epidemiology ,The essentials, Robert H.Fletcher, 1998

mo vl eni s xar i s xi
• mo vl eni s xar i s xi ( ER-RISK)pac i ent T a
pr o po r c i a i m j gu f Si r o mel Si c mo vl ena
aRi ni Sneba. as e magal i T ad , T u 100 pac i ent i d an
mo vl ena 27 aReni Sneba, maSi n mo vl eni s xar i s xi
0,27. s ako nt r o l o mo vl eni s xar i s xi (CER) d a
eqs per i ment u l i mo vl eni s xar i s xi (EER)
gamo i yeneba eqs per i ment u l d a s ako nt r o l o
j gu f ebSi am maCvenebl i s as axs nel ad

• EER = A/(A+B)%
• CER = C/(C+D)%

movlenis xarisxi ( ER-RISK) - pacientTa proporcia im jgufSi romelSic movlena aRiniSneba,

cal-calke eqsperimentuli da sakontrolo jgufebisaTvis. ase magaliTad, Tu eqsperimentuli jgufis
100 pacientidan daavadda 27 pacienti, maSin esperimentuli jgufis movlenis xarisxi 0,27 (EER =
A/(A+B)%), xolo sakontrolo jgufis movlenis xarisxi gamoiTvleba formuliT - CER = C/(C+D)
%. sakontrolo (CER) da eqsperimentuli movlenis xarisxi (EER) SefardebiT SesaZlebelia
gamovTvaloT riskTa fardoba anu fardobiTi riski(RR), roelic warmoadgens avadobis
Tanafardobas pirebSi, romlebic ganicdian an ar ganicdian risk-faqtoris zemoqmedebas- RR =
EER/CER
 Perinatal death risk odds

Sans ebi d a r i s kebi 2 on 100 2/100 = 0,02 2/98 = O,O2

• Sans ebi (odds) d a al baT o bebi (risks) ar i s 20 on 100 20/100 = 0,20 20/80 = 0,25
al t er nat i u l i , magr am gans xvavebu l i meT o d ebi ,
r o ml ebi c gamo xat avs ko nkr et u l i mo vl eni s 50 on 100 50/100 = 0,50 50/50 = 1
ganvi T ar ebi s an ar ganvi T ar ebi s Ses aZl ebl o bas
• Sans T a T anaf ar d o ba (OR=A/B:C/D)-er T j gu f Si 80 on 100 80/100 = 0,80 80/20 = 4
mo vl eni s ganvi T ar ebi s Sans i s f ar d o ba meo r e
j gu f Si mi s i ganvi T ar ebi s Sans T an •Tu per i nat al u r i s i kvd i l o ba ganu vi Tar d a 100-d an 20 axal So bi l s , maSi n
per i nat al u r i s i kvd i l o bi s r i s ki i qneba = 0.20 = 20%.
• f ar d o bi T i r i s ki (RR=A/(A+B):C/(C+D)) an •per i nat al u r i s i kvd i l o bi s Sans i ar i s mkvd ar i axal So bi l ebi s Sef ar d eba
r i s kT a T anaf ar d o ba ar i s avad o bi s c o c xl ad d ar Ceni l axal So bi l Ta r i c xvTan (100-20 = 80) d a per i nat al u r i
T anaf ar d o ba pi r ebSi ,r o ml ebi c gani c d i an an ar s i kvd i l o bi s Sans i am SemTxvevaSi i qneba 20/80 = 0.25
gani c d i an r i s k-f aqt o r i s z emo qmed ebas .

• arsebobs ramdenime meTodi riskis faqtorebis zemoqmedebasa da daavadebis ganviTarebas

Soris urTierTkavSiris SefasebisaTvis. es xerxebi gamoiyeneba riskebis Sesafaseblad da
ewodebaT efeqtis Sefaseba. ganasxvaveben efeqtis Sefasebis 4 saxes, erT-erTi maTgania
fardobiTi riski ar atareba informaciul datvirTvas avadobis absoluturi riskis Sesaxeb, magram
pasuxobs SekiTxvas “ramdenad maRalia avadoba im pirTa Soris, romlebic ganicdian riskis
faqtorebis zemoqedebas, vidre im pirTa Soris, romlebic ar ganicdian risk-faqtorebis
zemoqmedebas? anu es aris risk-faqtorebis zemoqedebis qveS myofTa avadobis Sefardeba
riskis zegavlenis ar mqone pirTa avadobasTan. fardobiTi riski asaxavs zemoqmedebasa da
daavadebas Soris kavSiris siZlieres. RR gamoiyeneba randomizirebul da kohortul
kvlevebSi.
roca RR erTis tolia, es niSnavs rom or Sesadarebel jgufs Soris sxvaoba ar arsebobs indicates
no difference in the occurrence of the condition of interest between the two comparison
groups (exposed and unexposed)
Tu RR metia 1-ze greater than 1 suggests that exposure is associated with increased
risk of the target condition compared with nonexposure.
Tu RR 1-ze naklebiathan 1 suggests that exposure is associated with decreased risk
compared with nonexposure.
• Sansebi da riskebi moicavs erTsa da imave informacias, magram gansxvavebulad
gamosaxavs mas. Tu movlenis ganviTarebis risks gamovsaxavT P, maSin am movlenis
Sansi iqneba P/(1-P). mag. Tu gamojanmrTelebis riski 0,3, maSin gamojanmrTelebis
Sansi iqneba 0,3/(1-0,3)=0,43. mag. Tu movlenis riski 0,2 (20%), maSin misi ar
ganviTarebis riski 0,8 (80%) iqneba, xolo movlenis Sansi iqneba 0.2/0.8 = 0.25.
• Tu perinataluri sikvdiloba ganuviTarda 100-dan 20 axalSobils, maSin perinataluri
sikvdilobis riski iqneba = 0.20 = 20%.
• perinataluri sikvdilobis Sansi aris mkvdari axalSobilebis Sefardeba cocxladdarCenil
axalSobilTa ricxvTan (100-20 = 80)
• da perinataluri sikvdilobis Sansi am SemTxvevaSi iqneba 20/80 = 0.25

Clinical Epidemiology ,The essentials, Robert H.Fletcher, 1998

 abs o l ut ur i r i s ki s d aqvei Teba
f ar d o bi Ti r i s ki s Semc i r eba
(RRR) • abs o l ut ur i r i s ki s d aqvei Teba
• mo vl eni s Sec i r ebi s pr o c ent i ar i s s ako nt r o l o d a exs per i men-
namku r nal ebi j gu f i s mo vl eni s t ul i mo vl eni s xar i s xs So r i s
xar i s xi s (EER) s ako nt r o l o
j gu f i s mo vl eni s xar i s xT an (CER)
gans xvaveba
Sed ar ebi s as
• c u d i gamo s avl i s pr o po r c i u r i ARR = CER - EER.
d aqvei T eba kvl evi s eqs per i ent al u r
d a s ako nt r o l o j gu f ebi s
mo nawi l eT a So r i s

avad myo f T a r i c xvi , r o mel T a

mku r nal o ba au c i el ebel i a (NNT)
• NNT i Zl eva po pu l ac i i s aT vi s
Cat ar ebu l i Car evi s s ar gebl o bi s
kl i ni ku r ad mni Svnel o van Sef as ebas
• NNT gamo i T vl eba abs o l u t u r i
r i s ki s d aqvei T ebi s Sef ar d ebi T 1-
T an
• NNT = 1/ARR1/ARR

arsebobs, mkurnalobis ori meTodis efeqturobis SedarebiTi Sefasebis ramdenime meTodi,

romelTa Soris yvelaze misaReb da mniSvnelovan klinikuri maCvenebels warmoadgens NNT,
avadmyofTa raodenoba, romelTa mkurnaloba aucilebelia, raTa Tavidan aviciloT erTi
arakeTilsaimedo gamosavali.

slaidebi ##33-55
or konkretul sakiTxze moyvanilia epidemiologiuri gaTvlis magaliTebi, romlebis gvaZleven
kvlevis rezultatebis interpretirebis saSualebas. pirveli magaliTi exeba asimptomuri baqteriis
mkurnalobis efeqturobis dadgenas, xolo meore magaliTis sasualebiT davadgenT, Tu ramdenad
efeqturia oraluri kontraceptivebis gamoyeneba orsulobis Tavidan acilebis mizniT. meore agaliTi
ganxilvamde
 s t at i s t i ki s mi mo xi l va

r i s kTa f ar d o baRR = A/(A+B)r i s ki eqs per i ment u l j gu f Si

C/(C+D)r i s ki pl ac ebo s j gu f Si

RR = EER/CER

d aavad eba
+ -
+ A B
mkur nal o ba
- C D

•f ar d o bi Ti r i s ki s d aqvei Teba (RRR) = 1- r i s kTa

Tanaf ar d o ba

• If RR 0.74, RRR = 1 - 0.74 = 0.26

rogor ganvsazRvroT riski, namdvilad aris igi momatebuli? populacia, romelic iyo sakontrolo da
mkurnalobis mizniT iRebda raime gamosakvlev preparats aris jgufi (A+B), xolo meore jgufi, anu
sakontrolo aris (C+D) populacia, romelic ar Rebulobda mkurnalobas. droTa ganmavlobaSi
daavadeba pacientebs uviTardebaT orive jgufSi, eqsperimentul jgufSi es arian pacientebi (A),
xolo sakontrolo jgufSi – pacientebi(C).

s ar wmu no ebi s i nt er val i

confidence interval
• war mo ad gens s t at i s t i ku r maCvenebel s , r o mel i c
s aSu al ebas gvaZl evs Sevaf as o T , T u r a
f ar gl ebSi Zevs mo c emu l i par amet r i s WeSmar i t i
mni Svnel o ba po pu l ac i aSi
anu
• s ar wmu no ebi s i nt er val i WeSmar i t mni Svnel o -
baT a mer yeo bi s d i apaz o ns war mo ad gens

• s ar wmu no ebi s i nt er val i s s i d i d e gamo xat avs

mo nac emT a d amt ki c ebu l o bi s xar i s xs

kvlevis monacemTa ukeT interpretirebisaTvis (mag, Tu radenad efeqturia magniumis sulfatis

gamoyeneba diazepamTan SedarebiT preeklamfsiis dros), unda gavceT pasuxi SekiTxvas:
rogoria is SesaZlo dasaSvebi intervali, romlis farglebSi mdebareobs WeSmariti mniSvneloba?
sarwmunoebis intervali warmoadgens maCvenebelTa limits, rommlis SigniT mdebareobs
WeSmariti mniSvneloba. rac naklebia arCevani, miT ufro farTea sarwmunoebis intervali,
arCevanis gazrdasTan erTad sarwmunoebis intervali mcirdeba da uaxlovdeba wertilovan

Sefasebas. sarwmunoebis intervalis saSualebiT rezultatebis interpretireba sasualebas gvaZlevs

Tavidan aviciloT rezultatebis gagebis ubralo diqotomiuri midgoma- ki an ara, magaliTad Tu
jgufebs Soris letalobis absoluturi sxvaoba 5 %, 95%-iani sarwmunoebis intervali am
maCveneblis garSemo mdebareobs 1,2%-dan-12%mde, rac niSnavs, rom letalobis savaraudo
sxvaoba 5%, magram WeSmariti sxvaoba SeiZleba iyos1,2%-dan 12%-mde. 95%-iani
WeSmaritebis intervali gulisxmobs, rom sididis WeSmariti mniSvneloba 95%-iani albaTobiT
am intervalSi mdebareobs. slaidebi ##56-62 moyvanilia imis magaliTebi, Tu ramdenad cvlis
pacientTa raodenoba miRebul maCveneblebs, rogor icvleba sarwmunoebis intervalis diapazoni
da meta-analizis Sedegebi. sxvadasxva RR pireobebSi sarwmonoebis intervalis diapazoni
sxvadasxva iyo. aseTi midgoma gansakuTrebiT Rirebulia, roca ganixileba erTi konkretuli
sakiTxi da arsebobs ramdenime sarwmuno, magram gansxvavebuli maCvenebeli.
 4) mt ki c ebu l ebebi s kl i ni ku r
pr aqt i kaSi gamo yeneba
• mt ki c ebu l ebi s i nt egr i r eba
pac i ent i s i nt er es ebT an, ko nkr et u l
gar emo ebebT an d a kl i ni ku r
gamo c d i l ebas T an
• am nabi j i s gans axo r c i el ebi s
wi napi r o bas war mo ad gens s abaz i s o
kl i ni ku r i c o d na d a gamo c d i l eba

• umjobesia mtkicebiTi medicinis swavleba klinikur kaTedrebze romelime klinikuri Temis

ganxilvisas, umjobesia iseTi studentebisaTvis swavleba, romelTac gaaCniaT garkveuli
klinikuri codna. mtkicebiTi medicinis praqtikuli mecadineobisaTvis, biostatistikis
meTodebis daxvewisa da kritikuli SefasebisaTvis umjobesia muSaoba mcire jgufebSi,
sasurvelia, rom mtkicebiTi medicina warmoadgendes samedicino saswavleblis
ganaTlebis politikas da mas xSirad ubrundebodnen, rogorc pre- aseve postdiplomuri
swavlebis procesSi. klinikuri codnis dagrovebasTan erTad studentebi ufro metad
aRiqvamen mm Rirebulebas da ukeT gamoiyeneben mas. ukeT danergvis mizniT
studentebs unda mieceT davaleba, konkretul klinikur SekiTxvaze moiZion
mtkicebulebebi da gaakeTon prezentacia. profesorebis mier yovelTviurad unda Catardes
prezentaciebi mm Sesaxeb, axali mtkicebulebebis ganxilva.

d i agno s t i ku r i t es t i
l abo r at o r i u l i t es t ebi
• d i agno s t i ku r i t es t i -kl i ni ku r i d aavad eba d aavad eba
t es t i , r o mel i c t ar d eba d aavad ebi s (+) (-)
gamo vl eni s mi z ni T t es t i + a b a+b
• mi Rebu l i r ez u l t at ebi u nd a
i Zl eo d es kl i ni ku r ad s as ar gebl o WeSmar i t ad cr u
i nf o r mac i as d a gvexmar ebo d es d ad ebi T i d ad ebi T i
kl i ni ku r i gad awyvet i l ebi s mi RebaSi t es t i - c d c+d
• s kr i ni ngu l i t es t i - t ar d eba r i s k- cr u WeSmar i t ad
f aqt o r i s gamo vl eni s d a ar a
u ar yo f i T i u ar yo f i T i
d i agno s t i ki s mi z ni T

d i agno s t i ku r i t es t ebi

• c r u u ar yo f i T i maCvenebel i -t es t i s
r ez u l t at ebi u ar yo f i T i a, T u mc a
pac i ent i r eal u r ad d aavad ebu l i a
• c r u d ad ebi T i maCvenebel i – t es t i s
r ez u l t at ebi d ad ebi T i a, T u mc a
pac i ent i r eal u r ad d aavad ebu l i ar
ar i s

diagnozis dadgenis procesi ar aris srulyofili, Cven mxolod SegviZlia vivaraudoT da

ara vamtkicoT, rom dignozi zustia. amitom eqims unda esmodes diagnostikuri
testebis maTematikuri arsi. testis rezultatebma unda gaaZlieros daavadebis arsebobis
 dadasturebis albaToba, eqimis mier miRebuli gadawyvetileba mkurnalobisa an
Carevis Sesaxeb diagnostikuri testebis rezultatebze dayrdnobiT unda miiRos. testma
unda SesZlos amoicnos daavadebis mqone da ar mqone pacientebi.
testis Sedegi SeiZleba iyos an dadebiTi (paTologia) an uaryofiTi (norma),
daavadeba SeiZleba arsebobdes an ararsebobdes. rezultatebis interpretirebis 4 varianti
arsebobs: WeSmaritad dadebiTi da WeSmaritad uaryofiTi da cru dadebiTi da cru
uaryofiTi. diagnostikuri testebis Sefasebisas, SesaZlebeli unda iyos cxrilis yvela
oTxive ujris Sevseba. am monacemebis gareSe SeuZlebelia mcdari diagnostikis riskis
Sefaseba, romelic TviToeuli testis mniSvnelovan maxasiaTebels warmoadgens.
skrininguli testis saSualebiT SesaZlebelia risk-faqtoris gamovlena. igi ar
gamoiyeneba diagnozis dasadgenad. ufro metic, skrininguli testis rezultatis normidan
gadaxris SemTxvevaSi, Tu eqimi SemdgomSi ar apirebs Semdgom kvlevasa da
mkurnalobas, maSin skrininguli testis Catareba azrs kargavs. idealuri skrininguli testi
unda tardebodes swrafad, ramdenime wuTis ganmavlobaSi, ar unda iyos saWiro
pacientis damatebiTi momzadeba da iyos iafi da usafrTxo. aseTi idealuri skrininguli
testis magaliTia arteriuli wnevis gazomva.

Clinical Epidemiology ,The essentials, Robert H.Fletcher, 1998

o qr o s s t and ar t i : magal i T ebi

d i agno s t i ku r i t es t i d aavad eba o qr o s s kr i ni ng-t es t i
“o qr o s s t and ar t i ”
s t and ar t i
et al o nu r i s t and ar t i -o qr o s s t and ar t i s aSvi l o s no s s aSvi l o s no s PAP-t es t i
• WeSmar i t i d aavad ebi s d i agno s t i r ebi s yel i s ki bo yel i s bi o f s i a
meT o d i s gans az Rvr a s aSar d e gz ebi s Sar d i s naT es i t es t -z o l i
• gans axi l vel i t es t i s Sed egebi i nf eqc i a
d ar d eba o qr o s s t and ar t s

diagnostikuri testis sizustis Sefaseba emyareba misi rezultatebis Sefasebas daavadebis

gansazRvris iseTi testis rezultatebs, romlebic miCneulia zustad da sandod, e.w. etalonur meTods
anu “oqros standarts”. vinaidan diagnozis dazustebis zusti meTodebi ZviradRirebulia da
TiTqmis yvela SemTxvevaSi DdidD riskTanaa dakavSirebuli, amitom ufro xSirad iyeneben ufro
martiv testebs. am SemTxvevaSi eqimebma unda gaaTvicnobieron, rom isini midian mcdari
diagnosis dasmis riskze da es gamarTlebulia mxolod im SemTxvevaSi, roca Secdomis riski
cnobilia da dasaSvebad dabalia. amisaTvis aucilebelia gvqondes am martivi testebis sizusti
“oqros standartTan” Sedarebis sarwmuno monacemebi. aRsaniSnavia, rom diagnostikuri
testebisagan gansxvavebiT skrininguli testebis “oqros standarts” warmoadgens ara sxva testi,
aramed prospeqtuli kvlevis rezultatebi.

Clinical Epidemiology ,The essentials, Robert H.Fletcher, 1998

 d aavad eba(+) d aavad eba(-) sul

d ad ebi T i a b a+b
t es t i WeSmar i t i c r u d ad ebi T i yvel a vi s ac
d ad ebi T i d ad ebi T i
t es t i aqvs
u ar yo f i T i c d c+d
t es t i cr u WeSmar i t i yvel a vi s ac
u ar yo f i T i u ar yo f i T i u ar yo f i T i
t es t i aqvs WES
sul a+c b+d
yvel a yvel a
d aavad ebi s d aavad ebi s ar
mqo ne mqo ne

mgr Zno bel o ba = a/(a+c)

WeSmar i t ad d ad ebi T i t es t i - yvel as aqvs d aavad eba.
d ad ebi T i t es t i s al baT o ba d aavad ebi s mqo ne pac i ent ebSi .

d aavad eba(+) d aavad eba(-) sul

d ad ebi T i a b a+b
t es t i WESmar i t i - c r u -d ad ebi T i yvel a vi s ac
mgr Zno bel o bi s gaT vl i s magal i T i d ad ebi T i d ad ebi T i
t es t i aqvs
u ar yo f i T i c d c+d
d aavad eba d aavad eba t es t i cr u - WeSmar i t i - yvel a vi s ac
(+) (-) u ar yo f i T I u ar yo f i T i u ar yo f i T i
t es t i 27 14 t es t i aqvs
(+) sul a+c b+d
t es t i 3 56 yvel a yvel a
d aavad ebi s d aavad ebi s ar
(-)
mqo ne mqo ne
100
s pec i f i u r o ba = d/(b+d)
mgr Zno bel o ba = a/(a+c) WeSmar i t ad u ar yo f i T i t es t i -yvel as ar a aqvs d aavad eba.
mgr Zno bel o ba = 27/30 u ar yo f i T i t es t i s al baT o ba pac i ent T an, r o mel s ac
= 90% d aavad eba ar aqvs

s pec i f i u r o bi s gamo T vl i s magal i T i

d aavad eba d aavad eba

(+) (-)
t es t i 27 14
(+)
t es t i 3 56
( -)
100

s pec i f i u r o ba = d/(b+d)
s pec i f i u r o ba = 56/(56+14)= 56/70
= 80%

xSirad eqimebs ar gaaCniaT informacia imis Sesaxeb, Tu maT mier praqtikulad gamoyenebuli
diagnostikuri testebi ramdenad Seesabameba absoluturad sarwmuno standarts. xSirad testis
sarwmunoebis dasadgenad xdeba misi Sedegebis Sedareba sxva testTan, romelic ar aris
srulyofili, magram iTvleba ukeTesad, e.i. xdeba ori saeWvo testis Sedareba, romelTagan erTerTi
iTvleba standartad, rasac xSirad paradoqsTan mivyavarT, aRmoCndeba, rom Sesadarebeli testi
ufro zustia. diagnostikuri testebis rezultatebisa da daavadebis realurad arsebobas an
ararsebobibas Soris urTierTkavSiris dasdgenad bevrad ufro mniSvnelovania testis
mgrZnobelobis da specifiurobis codna. mgrZnobeloba, es aris daavadebis mqone populaciaSi im
pirTa wili, romelTac gaaCniaT diagnostikuri testis dadebiTi rezultati, mgrZnobiare tetsti
iSviaTad tovebs pacientebs, romelTac gaaCniaT daavadeba. specifiuroba es aris daavadebis ar
mqone populaciaSi im pirTa wili, romelTac aReniSnaT testis uaryofiTi rezultati. specifiuri testi,
rogorc wesi ar miakuTvnebs janmrTel pacients daavadebulebis jgufs. diagnostikuri testis
arCevisas eqimma yuradReba unda miaqcios mis mgrZnobelobasa da specifiurobas.
mgrZnobiare testi gamoyenebul unda iqnas, roca arsebobs saSiSi, magram gankurnebadi
daavadebis gaparvis riski, an diagnostikuri Ziebis adreul stadiebze Ziebis CarCoebis daviwroebis
mizniT. amgvarad, eqimebisaTvis mgrZnobiare testi gansakuTrebiT informatiulia, roca is iZleva
uaryofiT Sedegs. specifiuri testebis gamoyeneba saWiroa diagnozis dadasturebis mizniT.
maRalspecifiuri testi iSviaTad iZleva dadebiT rezultats daavadebis ararsebobis SemTxvevaSi,
e.i. iSviTad aris cru dadebiTi. maRalspecifiuri testis gamoyeneba gansakuTrebiT
mniSvnelovania, roca cru dadebiTma pasuxma SesaZlebelia paciants miayenos finansuri,
fizikuri an emocionaluri zarali. amgvarad, specifiuri testi diagnostikurad gansakuTrebiT
efeqturia, roca is iZleva dadebiT rezultats. sasurvelia, rom diagnostikuri testi erTdroulad iyos
maRalmgrZnobiarec da maRalspecifiuric, rac samwuxarod Znelad misaRwevia. kargi
skrininguli testic unda iyos maRalmgrZnobiare da maRalspecifiuri da skrininguli testis
mgrZnobeloba da specifiuroba iseve isazRvreba, rogorc diagnostikuri testis SemTxvevaSi.

Clinical Epidemiology ,The essentials, Robert H.Fletcher, 1998

pr o gno z u l i Ri r ebu l eba pr o gno z u l i Ri r ebu l eba

• pr o gno z u l i Ri r ebu l eba: i mi s
al baT o ba, r o m d i agno s t i ku r i
t es t i z u s t ad as axavs d aavad ebi s
ar s ebo bas an ar ar s ebo bas
• d amo ki d ebu l i a:
t es t i s mgr Zno bel o baz e
t es t i s s pec i f i u r o baz e
d aavad ebi s gavr c el ebaz e
d ad ebi T i r ez u l t at i s
pr o gno z u l i
Ri r ebu l eba
• i mi s al baT o ba, r o m
t es t i s d ad ebi T i
r ez u l t at i s mqo ne
pac i ent i s i namd vi -
l eSi (namd vi l ad )
d aavad ebu l i a
u ar yo f i T i r ez u l t at i s
pr o gno z u l i
Ri r ebu l eba
• i mi s al baT o ba, r o m
t es t i s u ar yo f i T i
r ez u l t at i s mqo ne
pac i ent i s i namd vi -
l eSi (namd vi l ad ) ar
ar i s d aavad ebu l i

testis prognozuli Rirebuleba damokidebulia rogorc testis mgrZnobelobasa da specifiurobaze,

aseve gamosakvlev populaciaSi daavadebis gqavrcelebaze, anu mocemuli drois momentisaTvis
garkveul populaciaSi Sesaswavli daavadebis mqone pirTa wili. dadebiTi rezultatis prognozuli
Rirebuleba = mgrZnobeloba Xgavrceleba / (mgrZnobelobaXgavrceleba)- (1-mgrZnobeloba)X(1-
gavrceleba). rac ufro mgrZnobiarea testi, miT ufro maRalia misi uaryofiTi rezultatis prognostuli
Rirebuleba, anu matulobs eqimis rwmena, rom testis uaryofiTi rezultati uaryofs daavadebis
arsebobas. piriqiT, rac ufro specifiuria testi, miT maRalia misi dadebiTi rezultatis prognozuli
Rirebuleba, anu eqimi darwmunebulia, rom testis dadebiTi rezultati adasturebs savaraudo
diagnozs. diagnostikuri testis dadebiTi da uaryofiTi rezultatebis prognozuli Rirebulebis
interpretacia icvleba daavadebis gavrcelebis mixedviT. mag. Tu gavrceleba dabalia, maSin
maRalspecifiuri testis dadebiTi rezultatebi upiratesad cru dadebiTi aRmoCndeba, xolo
maRalmgrZnobiare testis uaryofiTi rezultatebi ki- cru uaryofiTi.

Clinical Epidemiology ,The essentials, Robert H.Fletcher, 1998