COPD患者中的戒烟干预：随机试验的网络荟萃分析
2009/06/24
本研究对目前COPD患者中戒烟干预措施的有效性进行排序。对10个数据库进行检索，选取与戒烟咨询（SCC）有关的随机试验，其中可同时使用药物治疗或尼古丁替代治疗（NRT）。我们采用logistic 回归分析，在保留每项试验随机化的基础上对所有试验进行网络荟萃分析，评价戒烟干预措施的有效性。8项试验中有6项符合本研究要求，其中包括7372名COPD患者。
结果显示，在长期戒断率上，SCC联合NRT治疗最为有效（与常规治疗相比的OR值为5.08, P<0.0001；与SCC单独治疗相比的OR值为2.80, P=0.001；与SCC＋抗抑郁治疗相比的OR值为1.53, P =0.28）。其次有效的治疗方案为SCC联合抗抑郁治疗（与常规治疗相比的OR值为3.32, P =0.002；与SCC单独治疗相比的OR值为1.83, P =0.007），但各抗抑郁治疗组间无显著性差异。与常规治疗相比，SCC单独治疗具有边缘优势（OR值为1.81, P =0.07）。少数研究证据显示，在COPD患者中，SCC联合NRT治疗较其它单独或联合治疗更为有效，但需要更多的研究进行证实。
结果显示，在长期戒断率上，SCC联合NRT治疗最为有效（与常规治疗相比的OR值为5.08, P<0.0001；与SCC单独治疗相比的OR值为2.80, P=0.001；与SCC＋抗抑郁治疗相比的OR值为1.53, P =0.28）。其次有效的治疗方案为SCC联合抗抑郁治疗（与常规治疗相比的OR值为3.32, P =0.002；与SCC单独治疗相比的OR值为1.83, P =0.007），但各抗抑郁治疗组间无显著性差异。与常规治疗相比，SCC单独治疗具有边缘优势（OR值为1.81, P =0.07）。少数研究证据显示，在COPD患者中，SCC联合NRT治疗较其它单独或联合治疗更为有效，但需要更多的研究进行证实。
（刘国梁 审校）
Strassmann R, et al. Eur Respir J. 2009 Apr 8. [Epub ahead of print]
Smoking cessation interventions in COPD - A network meta-analysis of randomised trials
The aim of this study was to rank order the effectiveness of smoking cessation interventions for COPD patients. We searched 10 databases to identify randomised trials of smoking cessation counselling (SCC) with or without pharmacotherapy or nicotine replacement therapy (NRT). We conducted a network meta-analysis using logistic regression analyses to assess the comparative effectiveness of smoking cessation interventions while preserving randomisation of each trial. The analysis of 7372 COPD patients from six out of eight identified trials showed that SCC in combination with NRT had the greatest effect on prolonged abstinence rates (odds ratio versus usual care 5.08, p<0.0001, versus SCC alone 2.80, p=0.001, and versus SCC combined with an antidepressant 1.53, p=0.28). The second most effective intervention was SCC combined with an antidepressant (odds ratio versus usual care 3.32, p=0.002, and versus SCC alone 1.83, p=0.007) without a difference between antidepressants. SCC alone was of borderline superiority compared with usual care (odds ratio 1.81, p=0.07).A small body of evidence suggests that SCC combined with NRT is more effective than other combinations and single smoking cessation treatments in COPD but substantially more research is needed for this most important COPD treatment.
上一篇：
使用基于电话随访的干预措施来支持非吸烟者辅助吸烟者戒烟的可行性：初步研究
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不同疾病处理水平对戒烟的影响：随机试验
