安非他酮戒除心血管疾病吸烟患者烟瘾有效性与安全性的Meta分析

Effectiveness and Safety of Bupropion for Smoking Cessation in Smokers with Cardiovascular Disease: A Meta-Analysis

目的系统评价安非他酮与安慰剂比较戒除心血管疾病吸烟患者烟瘾的有效性和安全性。方法计算机检索PubMed、EMbase、Web of Science、h e Cochrane Library、CBM、CNKI、WanFang Data和VIP数据库,收集安非他酮与安慰剂比较戒除心血管疾病吸烟患者烟瘾的随机对照试验(RCT),检索时限均从建库至2013年2月23日。由2位研究者根据纳入标准独立筛选文献、提取资料和评价纳入研究的方法学质量后,采用RevMan 5.1软件进行Meta分析。结果最终纳入4个RCT,共1415例患者。Meta分析结果显示,安非他酮与安慰剂相比,能提高3个月的点戒烟率[RR=1.79,95%CI(1.14,2.83),P=0.01],但两组在6个月、1年的点戒烟率[RR=1.81,95%CI(0.77,4.24),P=0.18;RR=1.46,95%CI(0.94,2.27),P=0.10]及3个月、6个月、1年连续戒烟率[RR=1.48,95%CI(0.89,2.47),P=0.13;RR=1.41,95%CI(0.79,2.51),P=0.25;RR=1.43,95%CI(0.93,2.17),P=0.10]方面,差异无统计学意义。两组在全因死亡率和心血管事件发生率方面差异也无统计学意义[RR=1.13,95%CI(0.49,2.56),P=0.78;RR=1.25,95%CI(0.95,1.64),P=0.11]。结论安非他酮治疗心血管疾病吸烟患者是安全的,可提高3个月的点戒烟率,但并不能提高长期戒烟率。受纳入研究数量和样本量所限,上述结论仍需更多高质量研究结果证实。

Objective To systematically review the effectiveness and safety of bupropion for smoking cessation in smokers with cardiovascular disease. Methods Databases including The Cochrane Library, PubMed, EMbase, Web of Science, CBM, CNKI, WanFang Data and VIP databases were electronically searched from inception to February 23rd, 2013. Randomized controlled trials （RCTs） on bupropion versus placebo for smoking cessation in smokers with cardio- vascular disease were included. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted the data, and assessed the methodological quality of included studies. Meta-analysis was performed by using RevMan 5.1 software. Results In total, 4 studies involving 1 415 patients were finally included. The results of meta- analyses indicated that, compared with placebo, bupropion significantly increased the point prevalence abstinence rate at 3 months （RR=1.79, 95%CI 1.14 to 2.83, P=0.01）. However, the point prevalence abstinence rates at 6 months （RR=1.81, 95%CI 0.77 to 4.24, P=0.18） and 12 months （RR=1.46, 95%CI 0.94 to 2.27, P=0.10）, and the continuous abstinence rates at 3 months （RR=1.48, 95%CI 0.89 to 2.47, P=0.13）, 6 months （RR=I.41, 95%CI 0.79 to 2.51, P=0.25）, and 12 months （RR=1.43, 95%CI 0.93 to 2.17, P=0.10） were similar in the two groups. The use of bupropion did not increase all-cause mortality （RR=1.13, 95%CI 0.49 to 2.56, P=0.78） and the incidence of cardiovascular events （RR=1.25, 95%CI 0.95 to 1.64, P=0.11）. Conclusion Bupropion is safe to use in smokers with cardiovascular disease. Although bupropion could increase the point prevalence abstinence rate at 3 months, it is not effective for long-term smoking cessation. Due to the limited quantity and quality of the included studies, more large-scale high-quality RCTs are required to verify the afore- mentioned conclusion.