伐尼克兰长期戒烟效果及安全性的Meta分析

发布时间：2018-03-16 12:37

本文选题：伐尼克兰　切入点：戒烟　出处：《苏州大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的：系统评价伐尼克兰相对于安慰剂、尼古丁替代疗法或安非他酮的长期戒烟效果及安全性。方法：系统检索截至2011年3月份之前在以下数据库的所有符合条件的文献：MEDLINE(OVID)(1946-2011年3月)、Cochrane随机试验注册中心(Cochrane Central Register of Controlled Trials)、Web of Science SCI(TS)、EMBASE(1966-2011年3月)和CNKI。同时手工检索参考文献和引文。纳入随机对照试验和类随机对照试验,同时干预组和对照组分别至少随访12个月的研究。对纳入文献采用Stata进行Meta分析。结果：检索收集到文献1022篇,剔除不符合要求文献1012篇,最终纳入了10项研究,共包括6375例吸烟者。伐尼克兰12个月的连续戒烟率OR为2.64(95%CI：2.08-3.36)。亚组分析的结果显示：相对于伐尼克兰未经滴定的研究来说,伐尼克兰经滴定到1mg,每天两次的研究发现的戒烟效果相对要差(RR,2.45vs.2.64),且两组研究之间并没有显著的异质性(p=0.338)。同时伐尼克兰对慢性阻塞性肺部疾病的患者的戒烟疗效(RR,3.33,95%CI：1.88to5.89)似乎要比对心血管疾病患者(RR,2.64,95%CI：1..72to4.05)以及对健康吸烟者(RR,2.52,95%CI：2.09to3.03)的戒烟效果均要明显；同时未包含亚洲人群的研究发现的戒烟效果要好于包含了亚洲人群的研究发现的戒烟效果(RR,2.98vs.1.94),年老者好于年轻者(RR,2.87vs.2.52),男性好于女性(RR,2.98vs.1.94)。与安慰剂相比,伐尼克兰(1mg BID)在第12个月最常发生的5种一般性不良反应包括：呕吐(RR,3.75；95%CI：2.25to6.27；12==0.0%,异质性检验的P值为0.515),恶心(RR,3.14；95%CI：2.70to3.66；I2=0.0%,异质性检验的P值为0.787),多梦(RR,2.78；95%CI：2.07to3.73；I2=21.9%,异质性检验的P值为0.255),便秘(RR,2.27；95%CI：1.47to3.49；I2=40.9%,异质性检验的P值为0.118),和味觉障碍(RR,2.20；95%CI：1.44to3.37；I2=0.0%,异质性检验的P值为0.450)。同时,服用伐尼克兰(1mg BID)发生精神相关性疾病的概率并没有显著高于安慰剂对照组(RR,1.45,95%CI：0.90to2.32；I2=0.0%,异质性检验的P值为0.845)。结论：基于现有的证据,伐尼克兰相对于安慰剂对照,前者12个月的戒烟效果明显强于后者。然而,由于本研究在设计分析过程中还存在一些不足之处,故以后需要更多、更高质量的研究来证实是否伐尼克兰真的增加精神疾病的发病率。同时,患有精神疾病的患者应该慎重服用伐尼克兰来戒烟。
[Abstract]:Objective: to systematically evaluate the relationship between Varnikram and placebo. Long-term smoking cessation efficacy and safety of nicotine replacement therapy or bupropion. Methods: a systematic search was made of all eligible literature on: MEDLINE OVIDI on the following database as of March 2011: Cochrane: Cochrane Random trial Registry, March 1946-2011. Central Register of Controlled trialsof Science SCISCO (March 1966-2011) and CNKI.The manual retrieval of references and citations. At the same time, the intervention group and control group were followed up for at least 12 months. Stata was used for Meta analysis. Results: 1022 articles were retrieved, 1012 articles were excluded and 10 studies were included. A total of 6375 smokers were included. The odds ratio of quitting smoking for 12 months was 2.64 / 95 CI: 2.08-3.360.The results of the subgroup analysis showed that compared to the untitrated study of Vannickland, Vannickland was titrated to 1 mg, and two studies a day found a relatively poor smoking cessation effect, and there was no significant heterogeneity between the two groups. At the same time, Vannickland's effect on smoking cessation in patients with chronic obstructive pulmonary disease was RRN 3.395 CIW 1.88to5.89). It seemed to be more effective than that for patients with cardiovascular disease (RRX 2.64% 95 CI: 1...72to4.05) and for healthy smokers (RRX 2.52% CI: 2.09 to 3.03). At the same time, the smoking cessation effect of the study without Asian population was better than that of the study including Asian population. The effect of smoking cessation was higher than that of RRN 2.98 vs.1.94, the elderly was better than the young, and the male was better than the female, and the male was better than the female, compared with the placebo. The five most common adverse reactions in the 12th month included: vomiting RRN 3.7595 CI2.25to6.27120.0.00.0.15 for heterogeneity test, P 0.515 for heterogeneity test, 2.70to 3.66I20.00 for nausea, 0.787g for heterogeneity test, 2.7895CI2.07to 3.73CI2.07to 3.73CI221.9T for heterogeneity test, 0.255for heterogeneity test, 2.2795for constipation, 2.2795for constipation. The P value of heterogeneity test was 0.118, and that of taste disorder was 2.2095%, and that of CI: 1.44 to 3.37 I ~ (2 +) was 0.00.The P value of heterogeneity test was 0.450%. There was no significant difference in the risk of psychologically related diseases in patients taking Vannickland (1 mg BID1 mg) compared with that in the placebo control group (P = 0.845). The ratio of CI: 0.90 to 2.32 mg BID was 0.90 to 2.32, and the P value of heterogeneity test was 0.845. Conclusion: based on the available evidence, the 12 months smoking cessation effect of Vannickland was significantly better than that of placebo control. However, there were still some deficiencies in the design analysis of this study, so more was needed in the future. Higher quality studies confirm whether Vannickland really increases the risk of mental illness. Meanwhile, people with mental illness should be careful to take Vannickland to quit smoking.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R163

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