孕妇戒烟咨询的效果——随机对照试验荟萃分析
2011/11/22
摘要
背景：医生向吸烟孕妇推荐的多手段戒烟干预措施中常常包括戒烟咨询。然而，单独戒烟咨询对于吸烟孕妇戒烟的效果尚不清楚，单独报道的随机对照试验（RCT）也未有最终的结论。
目的：对RCT进行荟萃分析，研究戒烟咨询对吸烟孕妇戒烟的效果。
检索策略：通过检索CDC烟草信息和预防网、Cochrane图书馆、EMBASE、Medline和PsycINFO数据库，找出评价戒烟咨询的RCT。
选择标准：入选与孕妇有关的RCT，这些试验研究单独戒烟咨询的效果，而且在目标戒烟时间后6个月或12个月通过生化检测证实有效戒断。
数据搜集和分析：利用随机效应荟萃分析模型进行总体评估。
主要结果：共找到8项RCT（包括3290例女性），所有RCT均研究戒断6个月后的情况。在随访结束后仍处于戒断状态的女性比例适中（戒烟咨询组：4～24%；对照组：2～21%）。戒断的最大绝对差异仅为4%。虽然有不多的证据显示戒烟咨询能有效促进戒断，但是由于可信区间较大，未能得出最终的结论（优势比：1.08,95%CI：0.84–1.40）。没有证据显示，戒烟咨询的类型会影响戒烟效果。
结论：已有关于戒烟咨询对吸烟孕妇戒烟影响的RCT仍然有限，但可以排除其具有明显治疗效果。未来的RCT应该在该人群中研究药物治疗措施。
（陈欣 审校）
BJOG. 2011 Aug 22. doi: 10.1111/j.1471-0528.2011.03065.x. [Epub ahead of print]
The effect of smoking cessation counselling in pregnant women: a meta-analysis of randomised controlled trials.
Filion K, Abenhaim H, Mottillo S, Joseph L, Gervais A, O’Loughlin J, Paradis G, Pihl R, Pilote L, Rinfret S, Tremblay M, Eisenberg M.
Source
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA Department of Obstetrics and Gynecology Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital Faculty of Medicine, University of Montreal Department of Epidemiology, Biostatistics and Occupational Health, McGill University Division of Clinical Epidemiology, McGill University Health Center Agence de la santé et des services sociaux, Direction de santé publique Centre de Recherche du Centre Hospitalier de l’Université de Montréal and Department of Social and Preventive Medicine, University of Montreal Department of Psychology, McGill University Division of Internal Medicine, McGill University Health Center, Montreal Clinical and Interventional Cardiology, Multidisciplinary Cardiology Department, Laval Hospital, Quebec Heart and Lung Institute, Sainte-Foy Développement des individus et des communautés, Institut national de santé publique, Montreal, QC, Canada.
Abstract
BACKGROUND：Pregnant smokers are often prescribed counselling as part of multicomponent cessation interventions. However, the isolated effect of counselling in this population remains unclear, and individual randomised controlled trials (RCTs) are inconclusive.
OBJECTIVE：To conduct a meta-analysis of RCTs examining counselling in pregnant smokers.
SEARCH STRATEGY：We searched the CDC Tobacco Information and Prevention, Cochrane Library, EMBASE, Medline and PsycINFO databases for RCTs evaluating smoking cessation counselling.
SELECTION CRITERIA：We included RCTs conducted in pregnant women in which the effect of counselling could be isolated and those that reported biochemically validated abstinence at 6 or 12 months after the target quit date.
DATA COLLECTION AND ANALYSIS：Overall estimates were derived using random effects meta-analysis models.
MAIN RESULTS：Our search identified eight RCTs (n = 3290 women), all of which examined abstinence at 6 months. The proportion of women that remained abstinent at the end of follow up was modest, ranging from 4 to 24% among those randomised to counselling and from 2 to 21% among control women. The absolute difference in abstinence reached a maximum of only 4%. Summary estimates are inconclusive because of wide confidence intervals, albeit with little evidence to suggest that counselling is efficacious at promoting abstinence (odds ratio 1.08, 95% confidence interval 0.84–1.40). There was no evidence to suggest that efficacy differed by counselling type.
CONCLUSIONS：Available data from RCTs examining the isolated effect of smoking cessation counselling in pregnant women are limited but sufficient to rule out large treatment effects. Future RCTs should examine pharmacological therapies in this population.
BJOG. 2011 Aug 22. doi: 10.1111/j.1471-0528.2011.03065.x. [Epub ahead of print]
背景：医生向吸烟孕妇推荐的多手段戒烟干预措施中常常包括戒烟咨询。然而，单独戒烟咨询对于吸烟孕妇戒烟的效果尚不清楚，单独报道的随机对照试验（RCT）也未有最终的结论。
目的：对RCT进行荟萃分析，研究戒烟咨询对吸烟孕妇戒烟的效果。
检索策略：通过检索CDC烟草信息和预防网、Cochrane图书馆、EMBASE、Medline和PsycINFO数据库，找出评价戒烟咨询的RCT。
选择标准：入选与孕妇有关的RCT，这些试验研究单独戒烟咨询的效果，而且在目标戒烟时间后6个月或12个月通过生化检测证实有效戒断。
数据搜集和分析：利用随机效应荟萃分析模型进行总体评估。
主要结果：共找到8项RCT（包括3290例女性），所有RCT均研究戒断6个月后的情况。在随访结束后仍处于戒断状态的女性比例适中（戒烟咨询组：4～24%；对照组：2～21%）。戒断的最大绝对差异仅为4%。虽然有不多的证据显示戒烟咨询能有效促进戒断，但是由于可信区间较大，未能得出最终的结论（优势比：1.08,95%CI：0.84–1.40）。没有证据显示，戒烟咨询的类型会影响戒烟效果。
结论：已有关于戒烟咨询对吸烟孕妇戒烟影响的RCT仍然有限，但可以排除其具有明显治疗效果。未来的RCT应该在该人群中研究药物治疗措施。
（陈欣 审校）
BJOG. 2011 Aug 22. doi: 10.1111/j.1471-0528.2011.03065.x. [Epub ahead of print]
The effect of smoking cessation counselling in pregnant women: a meta-analysis of randomised controlled trials.
Filion K, Abenhaim H, Mottillo S, Joseph L, Gervais A, O’Loughlin J, Paradis G, Pihl R, Pilote L, Rinfret S, Tremblay M, Eisenberg M.
Source
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA Department of Obstetrics and Gynecology Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital Faculty of Medicine, University of Montreal Department of Epidemiology, Biostatistics and Occupational Health, McGill University Division of Clinical Epidemiology, McGill University Health Center Agence de la santé et des services sociaux, Direction de santé publique Centre de Recherche du Centre Hospitalier de l’Université de Montréal and Department of Social and Preventive Medicine, University of Montreal Department of Psychology, McGill University Division of Internal Medicine, McGill University Health Center, Montreal Clinical and Interventional Cardiology, Multidisciplinary Cardiology Department, Laval Hospital, Quebec Heart and Lung Institute, Sainte-Foy Développement des individus et des communautés, Institut national de santé publique, Montreal, QC, Canada.
Abstract
BACKGROUND：Pregnant smokers are often prescribed counselling as part of multicomponent cessation interventions. However, the isolated effect of counselling in this population remains unclear, and individual randomised controlled trials (RCTs) are inconclusive.
OBJECTIVE：To conduct a meta-analysis of RCTs examining counselling in pregnant smokers.
SEARCH STRATEGY：We searched the CDC Tobacco Information and Prevention, Cochrane Library, EMBASE, Medline and PsycINFO databases for RCTs evaluating smoking cessation counselling.
SELECTION CRITERIA：We included RCTs conducted in pregnant women in which the effect of counselling could be isolated and those that reported biochemically validated abstinence at 6 or 12 months after the target quit date.
DATA COLLECTION AND ANALYSIS：Overall estimates were derived using random effects meta-analysis models.
MAIN RESULTS：Our search identified eight RCTs (n = 3290 women), all of which examined abstinence at 6 months. The proportion of women that remained abstinent at the end of follow up was modest, ranging from 4 to 24% among those randomised to counselling and from 2 to 21% among control women. The absolute difference in abstinence reached a maximum of only 4%. Summary estimates are inconclusive because of wide confidence intervals, albeit with little evidence to suggest that counselling is efficacious at promoting abstinence (odds ratio 1.08, 95% confidence interval 0.84–1.40). There was no evidence to suggest that efficacy differed by counselling type.
CONCLUSIONS：Available data from RCTs examining the isolated effect of smoking cessation counselling in pregnant women are limited but sufficient to rule out large treatment effects. Future RCTs should examine pharmacological therapies in this population.
BJOG. 2011 Aug 22. doi: 10.1111/j.1471-0528.2011.03065.x. [Epub ahead of print]
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酒精依赖的吸烟者在恢复早期进行强化干预：随机试验
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住院患者康复治疗期间和治疗后网络戒烟干预的效果——半随机对照试验
