- 學位論文
使用varenicline單一藥物治療戒菸成功的相關因子
Factors Associated with Successful Smoking Cessation with Varenicline Monotherapy
摘要
前言：吸菸會導致許多疾病，卻是可預防的健康危害。台灣政府推行二代戒菸服務計劃來幫助吸菸者戒菸，服務包含門診診療、提供戒菸藥物、諮詢衛教和電話追蹤。戒菸藥物中又以varenicline最為有效，目前少有研究探討在國家戒菸服務計劃下的門診中使用varenicline單一藥物的相關影響因素。故本研究欲探討二代戒菸服務門診中接受varenicline單一藥物治療的吸菸者之成功戒菸的機率及相關影響因素。 方法：研究資料取自2014年1月至2018年6月至中部某醫學中心戒菸門診之20歲含以上737位吸菸者，本研究中所有患者僅接受varenicline單一藥物治療，根據病歷紀錄患者之年齡、性別、吸菸狀態、共病症、戒菸藥物、追蹤狀況和副作用。成功戒菸的定義是初次門診後六個月的7天點戒菸率且最後一次就診時吐氣一氧化碳濃度<10ppm。以卡方檢定各變項與成功戒菸之相關性，進而以多變項邏輯斯回歸模式分析，探討varenicline單一藥物治療之成功戒菸之相關因子。 結果：本研究中varenicline單一藥物治療的737名吸菸者（平均46.1±11.8歲；男性：85.6％）；平均一生吸菸量為32.6±23.8包*年；初診吸菸量、初診吐氣一氧化碳濃度和尼古丁成癮度Fagerström Test for Nicotine Dependence（FTND）分數分別為24.2±12.4支/天、13.7±10.0ppm和6.2±2.9分。737位吸菸者常見共病症為循環系統疾病(26.2%)、內分泌營養代謝疾病(23.9%)及消化系統疾病(14.4%)。使用varenicline的平均時長為4.2±2.6週，門診就診平均次數為2.1±1.2次，電話諮詢平均次數為4.2±1.7次。在初診後6個月的追蹤時，戒菸率為28.8％。運用多變項邏輯斯迴歸模式分析顯示，成功戒菸與男性吸菸者（勝算比為2.1；95％信賴區間為1.2至3.7；p = 0.014），尼古丁成癮度≤6分（勝算比為2.0；95％信賴區間為 1.4至2.9；P < 0.001），初診吐氣一氧化碳<10ppm（勝算比為3.0；95％信賴區間為2.1至4.3；p < 0.001），療程中使用varenicline >4週（勝算比為2.2；95％信賴區間為1.2至4.0；p = 0.013），門診就診次數>2次（勝算比為2.3；95％信賴區間為 1.2至4.2；p < 0.001）及電話諮詢次數>4次（勝算比為2.9；95％信賴區間為2.0至4.2；p < 0.001）顯著相關。 結論：吸菸者接受varenicline單一藥物治療時，男性、初次門診時的吐氣一氧化碳濃度<10ppm和輕中度尼古丁成癮度者(FTND ≤ 6分)的成功戒菸的機會較高；治療過程中，使用varenicline單一藥物>4週、門診就診次數>2次和電話諮詢次數>4次者越容易戒菸成功。
並列摘要
Objective: Smoking causes diseases and is a preventable health hazard. The Taiwanese government implements the Second Generation Cessation Services Payment Scheme to help smokers quit smoking. The services include physician’s advice, individual behavioral counseling, provision of medication and telephone counseling. Varenicline is the most effective smoking cessation medication. Few studies examined the factors associated with successful smoking cessation with using varenicline monotherapy under the national smoking cessation program at the outpatient smoking cessation services of medical centers. The objective of this study was to explore the factors associated with successful smoking cessation among smokers receiving varenicline monotherapy. Methods: Smokers aged≥20 years visiting the clinics of a university hospital in central Taiwan from January 2014 to June 2018 were enrolled under the smoking cessation program. All subjects only received varenicline monotherapy. Demographic information, comorbidities, smoking history questionnaires, measures of tobacco dependence, and treatment contacts were reviewed among these smokers and extracted from their electronic medical notes. Successful quitting was defined as the 7-day point prevalence abstinence rate at the 6-month follow-up and carbon monoxide (CO) level <10 ppm at final clinic visit. Logistic regression analysis was used to identify the factors of successful smoking cessation among the smokers with varenicline monotherapy. Results: Seven hundred and thirty-seven smokers receiving varenicline monotherapy (mean, 46.1±11.8 years; male: 85.6%) were included in the present study. Among the 737 smokers, the mean lifetime smoking amount was 32.6±23.8 pack-year; the cigarettes smoked per day, the mean CO level at first clinic visit and the mean the Fagerström Test for Nicotine Dependence (FTND) score at the first visit were 24.2±12.4, 13.7±10.0 ppm and 6.2±2.9 points, respectively. Most common comorbidities were diseases of circulatory system (26.2%), endocrine, nutritional and metabolic diseases (23.9%), disease of digestive system (14.4%). The mean length of varenicline prescription was 4.2±2.6weeks, the mean number of clinic visits was 2.1±1.2, and the mean number of telephone counselling was 4.7±1.7. The point prevalence abstinence rate was 28.8% at the 6-month follow-up. In the logistic regression analysis, the male smoker [odds ratio (OR), 2.1; 95% confidence interval (CI), 1.6-3.7; p = 0.014], FTND score ≤6 points (OR, 2.0; 95% CI, 1.4-2.9; p < 0.001), CO level at first clinic visit <10 ppm (OR, 3.0; 95% CI, 2.1-4.3; p < 0.001), length of vanrenicline prescription >4 weeks (OR, 2.2; 95% CI, 1.2-4.0; p = 0.013), number of clinic visits >2 times (OR, 2.3; 95% CI, 1.2-4.2; p = 0.009) and number of telephone counselling >4 times (OR, 2.9; 95% CI, 2.0-4.2; p < 0.001) were significantly associated with successful smoking cessation. Conclusion: In smokers receiving varenicline monotherapy, those male subjects, having lower FTND scores (≤6points) and CO level at first clinic visit (<10ppm) have higher chance of successful quitting. During the treatment, the length of varenicline prescription >4 weeks, the number of clinic visits >2 times and umber of telephone counselling >4 times played crucial roles in smoking cessation for adult smokers.