尼古丁依赖与烟瘾治疗(英文)

Nicotine dependence and smoking cessation

吸食烟草是世界上可以预防的致死、致残、引发疾病的重要因素之一,至2020年它可能成为所有发达国家和发展中国家要面对的头号健康问题。尼古丁是导致机体对烟草产生依赖的重要物质,作用于中枢神经系统,引起多巴胺等神经递质的释放。像其他产生依赖的化学物质一样,尼古丁被认为是激活中脑边缘多巴胺系统产生犒赏作用。有很多治疗尼古丁依赖的方法,目前被证实有效的有行为治疗(包括5A简单干预)和药物疗法2种。研究发现,5A简单干预是最好的简短干预方法之一,特别适用于工作繁忙的内科医师治疗成瘾者。尼古丁替换替代疗法(如皮肤贴剂、口香糖、吸入剂、鼻喷雾液、糖锭),安非他酮缓释剂和伐尼克兰3种药物疗法可用于解除烟瘾。伐尼克兰是一种新的α4β2尼古丁受体部分激动剂。III期临床试验显示,它可能比尼古丁替代和安非他酮更有效。伐尼克兰的常见不良反应有恶心等消化道症状,但较轻微,多可以忍受。但此药上市后有报告出现焦虑、抑郁和自杀的案例,故在伐尼克兰的使用说明中添加进了新的安全性警告。不过到目前为止,这些神经精神不良反应与服用伐尼克兰的因果关系尚未被证实。

Tobacco use is the single most preventable cause of death, disability and disease in the world and is projected to be the leading cause of death and disability across all developed and developing countries by 2020. Nicotine, the primary active ingredient of cigarettes that contributes to physical dependence, acts on nicotine receptors in the central nervous system and leads to the release of neurotransmitters （ such as dopamine）. Like other drugs of abuse, nicotine is thought to produce reinforcing effect by activating the mesocorticolimbic dopamine system. A wide variety of cessation treatments of nicotine dependence is commercially available, yet only 2 general approaches have received empirical validation： behavioral intervention （including 5 As brief intervention） and pharmacotherapy. The evidences show that 5 As brief intervention is one of the most cost-effective treatments in clinical work for busy physicians. Three types of medications have been available in market for smoking cessation treatment ： nicotine replacement treatment （NRT, i. e. , transdermal patch, gum, inhaler, nasal spray, and lozenge）, sustained release bupropion and varenicline. Varenicline, a novel 0t4152 nicotinic receptor partial agonist, is effective for tobacco dependence. Phase Ⅲ trials suggest that it is more effective than NRT and bupropion SR. The safety profile of varenicline is excellent, with the most commonly occurring adverse events, nausea, typically mild and well tolerated. However, new safety warnings are added to the varenicline label because of post-marketing report including agitation, depression and suicidality. A causal connection between varenicline use and these symptoms has not been established.