慢性阻塞性肺疾病吸烟者中与一年戒烟相关的临床特征和因素：一项多中心随机试验的亚组分析。
完整摘要 · 中文译文
背景：戒烟是改变慢性阻塞性肺疾病（COPD）临床病程最有效的干预措施，但许多患者在确诊后仍继续吸烟。我们在一项多中心随机戒烟试验中，评估了COPD吸烟者在一年时戒断的相关特征。 方法：这项预设亚组分析纳入了被随机分配至立即转诊至戒烟门诊或常规治疗的COPD患者。一年后的吸烟状态通过结构化电话访谈确定，已戒烟者予以联系，并通过呼出气一氧化碳测定进行戒断验证；220名患者中有48名（21.8%）失访，剩余172名患者纳入分析。拟合了预设的六变量logistic回归模型；Firth惩罚回归以及将失访患者归类为持续吸烟者的分析均为预设敏感性分析。 结果：在172例患者中，32例（18.6%）在一年时已戒烟：分配至立即转诊组的93例中有24例（25.8%）戒烟，而分配至常规治疗组的79例中有8例（10.1%）戒烟（p = 0.010）。在未校正比较中，戒烟者年龄较大且基线FEV1较低。在多变量模型中，常规治疗与较低的戒烟几率相关（OR，0.25；95% CI，0.09-0.64），而无合并症（OR，2.64；95% CI，1.06-6.60）和超过1次因急性加重相关住院（OR，9.32；95% CI，1.97-44.06）与较高的戒烟几率相关；后一估计基于10例患者，不精确。基线FEV1和Fagerström评分与戒烟无独立相关性。 结论：立即转诊至戒烟门诊是与一年戒断相关性最强的因素，同时还有无合并症以及（初步提示的）反复住院；仅在未校正比较中，疾病严重程度较高与戒烟相关。这些探索性发现支持在常规COPD诊疗中采用结构化戒烟路径。
完整摘要 · 英文原文
BACKGROUND: Smoking cessation is the most effective intervention for modifying the clinical course of chronic obstructive pulmonary disease (COPD), yet many patients continue to smoke after diagnosis. We evaluated the characteristics associated with cessation at one year among smokers with COPD in a multicentre randomised cessation trial. METHODS: This prespecified subgroup analysis included patients with COPD randomised to immediate referral to a smoking cessation clinic or to usual care. Smoking status one year later was determined through a structured telephone interview, and patients who had quit were contacted and their cessation was verified by exhaled carbon monoxide measurement; 48 of the 220 patients (21.8%) were lost to follow-up, leaving 172 patients for analysis. A prespecified six-variable logistic regression model was fitted; Firth penalised regression and an analysis classifying patients lost to follow-up as continuing smokers were prespecified sensitivity analyses. RESULTS: Of 172 patients, 32 (18.6%) had quit at one year: 24 of 93 (25.8%) allocated to immediate referral versus 8 of 79 (10.1%) allocated to usual care (p = 0.010). Quitters were older and had a lower baseline FEV1 in unadjusted comparisons. In the multivariable model, usual care was associated with lower odds of cessation (OR, 0.25; 95% CI, 0.09-0.64), whereas absence of comorbidity (OR, 2.64; 95% CI, 1.06-6.60) and more than 1 exacerbation-related hospitalisation (OR, 9.32; 95% CI, 1.97-44.06) were associated with higher odds; the latter estimate rests on 10 patients and is imprecise. Baseline FEV1 and Fagerström score were not independently associated with cessation. CONCLUSION: Immediate referral to a cessation clinic was the factor most strongly associated with one-year abstinence, together with absence of comorbidity and, tentatively, repeated hospitalisation; greater disease severity was associated with quitting only in unadjusted comparisons. These exploratory findings support structured cessation pathways in routine COPD care.