吸烟相关慢性病患者戒烟认知评估及伐尼克兰的干预作用

Evaluation of smoking-cessation awareness and intervention of varenicline for patients with chronic diseases related to tobacco

目的调查吸烟相关慢性病患者的戒烟意愿和戒烟认知水平,评估伐尼克兰的持续戒烟率和安全性。方法对121例吸烟相关慢性病患者进行戒烟问卷调查,有意愿药物戒烟者(87例)口服伐尼克兰(伐尼克兰组23例,0.5 mg·d-1×3 d,1 mg·d-1×4 d,2 mg·d-1×11 wk)进行12 wk前瞻性、开放,与干戒(干戒组64例)相比较的临床试验。随访观察呼出气一氧化碳证实的持续戒烟率、不良反应及戒断症状。结果伐尼克兰组和干戒组12 wk持续戒烟率分别为70%和22%,2组间有非常显著差异(P<0.01)。伐尼克兰组恶心的发生率为39%(9/23),与干戒组3%(2/64)有非常显著差异(P<0.01);其他不良反应包括失眠(5例)、头痛(2例)、疲乏(2例)、异常梦境(1例)等,程度轻微,多为一过性,与干戒组比较无显著差异(P>0.05)。治疗12 wk后2组的体重增加无显著差异(P>0.05)。伐尼克兰组12 wk戒断症状评分为(1.9±s 2.7)分,显著低于干戒组(2.9±1.6)分(P<0.05)。结论我国吸烟相关慢性病患者多数有戒烟愿望,但戒烟认知水平及戒烟理念仍待提高。伐尼克兰持续戒烟安全、有效,对我国吸烟相关慢性病患者具有适用性。

AIM To survey the intention and awareness of smoking cessation and to evaluate the efficiency and safety of varenicline for patients with chronic diseases related to tobacco. METHODS The intention of smoking cessation and the preferred ways to quit smoking were surveyed by questionnaire in 121 patients with chronic diseases related to tobacco. Thereafter, the patients who agreed with pharmacotherapy of smoking cessation were administrated with varenicline （varenicline group, n = 23, 0.5 mg-d^-1 × 3 d, 1 mg-d 1 × 4 d, 2 mg·d^-1 × 11 wk） in a 12-week post-marketing, prospective, and open-label study, and the adverse reaction and clinical efficacy of carbon monoxide-confirmed continuous abstinence rates （CAR） were compared with those who quitted smoking by means of cold turkey （cold turkey group, n = 64）. RESULTS There were significant difference in the CAR （70% vs. 22%） and the rate of adverse reactions of nausea （39% vs. 3%） between varenicline group and cold turkey group （P 〈 0.01） . The other common adverse drug case s of varenicline were insomnia （5 cases）, headache （2 cases）, fatigue （2 cases）, and abnormal dreams （1 case）, etc., which were generally in mild to moderate intensity and often diminished over time. There was no significant difference between the two groups in the increase of body weight during the 12-week treatment period （P 〉 0.05）. Mean withdrawal scale score was 1.9 ± s 2.7 in the varenicline groups and 2.9 ± 1.6 in the cold turkey group, showing significant difference （P 〈 0.05）. CONCLUSION The preferred way of smoking cessation for most of patients with chronic diseases related to tobacco was cold turkey, showing that the awareness of smoking cessation remains to be greatly improved. Varenicline was efficacious and safe, and can be well-tolerated for smoking cessation in Chinese patients with chronic diseases related to tobacco.