目的:确定同时吸烟和使用尼古丁替代疗法(NRT)对报道的吸烟沉重感的影响,尼古丁(可替宁)体液和呼出空气一氧化碳(CO)浓度。
方法:随机对照试验的系统评价和荟萃分析,哪些测试干预措施允许同时使用NRT和吸烟,并进行比较,在参与者中,吸烟时的结果与同时吸烟和使用NRT时的结果。测量包括报告的每天吸烟数量(CPD),体液可替宁和呼出的空气CO浓度。
结果:29项研究纳入本综述。九项研究的荟萃分析表明,与单独吸烟相比,使用NRT时,每天吸烟较少(同时吸烟和使用NRT时的平均差,-2.06CPD[95%CI=-3.06至-1.07,P<0.0001])。对七项研究的荟萃分析显示,在同时吸烟和使用NRT期间,呼出气CO的减少无统计学意义(平均差异,-0.58ppm[95%CI=-2.18至1.03,P=0.48]),但在测试NRT在退出之前使用的三项研究中(即作为预加载),呼出CO的类似减少具有统计学意义(平均差异,-2.54ppmCO[95%CI=-4.14至-0.95,P=0.002])。11项研究报告了可替宁浓度,但荟萃分析是不可能的,因为数据报告异质性;其中,七个报告的可替宁浓度较低,同时使用NRT和吸烟,四个报告没有差异,没有人报告浓度较高。
结论:吸烟和使用尼古丁替代疗法的人报告说,吸烟量低于单纯吸烟的人。当尼古丁替代疗法用于戒烟(预装),这种报道的减少吸烟已经得到生化证实。没有证据表明同时吸烟和使用尼古丁替代疗法比仅吸烟导致更大的尼古丁暴露。
OBJECTIVE: To determine effects of concurrent smoking and nicotine replacement therapy (NRT) use on reported heaviness of smoking, nicotine (cotinine) body fluid and exhaled air carbon monoxide (CO) concentrations.
METHODS: Systematic review and meta-analysis of RCTs, which test interventions permitting concurrent NRT use and smoking and comparing, within participants, outcomes when smoking with those when smoking and using NRT concurrently. Measurements included reported number of cigarettes smoked per day (CPD), body fluid cotinine and expired air CO concentrations.
RESULTS: Twenty-nine studies were included in the review. Meta-analysis of nine showed that, compared with when solely smoking, fewer cigarettes were smoked daily when NRT was used (mean difference during concurrent smoking and NRT use, -2.06 CPD [95% CI = -3.06 to -1.07, P < 0.0001]). Meta-analysis of seven studies revealed a non-significant reduction in exhaled CO during concurrent smoking and NRT use (mean difference, -0.58 ppm [95% CI = -2.18 to 1.03, P = 0.48]), but in the three studies that tested NRT used in the lead-up to quitting (i.e. as
preloading), a similar reduction in exhaled CO was statistically significant (mean difference, -2.54 ppm CO [95% CI = -4.14 to -0.95, P = 0.002]). Eleven studies reported cotinine concentrations, but meta-analysis was not possible because of data reporting heterogeneity; of these, seven reported lower cotinine concentrations with concurrent NRT use and smoking, four reported no differences, and none reported higher concentrations.
CONCLUSIONS: People who smoke and also use nicotine replacement therapy report smoking less heavily than people who solely smoke. When nicotine replacement therapy is used in the lead-up to quitting (
preloading), this reported smoking reduction has been biochemically confirmed. There is no evidence that concurrent smoking and nicotine replacement therapy use result in greater nicotine exposure than solely smoking.