为什么采用两种戒烟药物疗效好于一种药物：渴望抑制的作用
2011/12/26
摘要
目的：与单药或安慰剂戒烟的吸烟者相比，为什么联合药物戒烟的吸烟者更有可能戒烟。
方法：数据收集于参与戒烟临床试验的1504名吸烟者（58.2%的女性，83.9%的白人，平均年龄为44.67±11.08岁）。这些参与者随机分为6组，接受不同的戒烟治疗（安慰剂、尼古丁贴剂、尼古丁锭剂、安非他酮、尼古丁贴剂+尼古丁锭剂和安慰她同+尼古丁锭剂）。参与者完成每日4次的生态瞬时评估，关注5个药物治疗的假设的调节因素（负面影响，正面影响，渴望，吸烟期望和撤退症状）。治疗在戒烟后仍持续8～12周，其中进行6次个体咨询。采用新的贝叶斯方法，通过多重中介模型来估计中介路径。
结果：生化方法确定的8周戒断为主要的转归指标，单药和联合戒烟的戒断率分别为45%（n = 689）和54%（n = 478）。单变量模型分析显示，与单药戒烟相比，联合用药戒烟具有更高的戒断率，这与其抑制撤退症状、吸烟渴望和吸烟期望相关。然而，多重中介模型显示，戒烟日抑制吸烟渴望能产生最强的中介作用，是其他检测指标中介作用的原因。
结论：抑制戒烟日的吸烟渴望明显介导了单药和联合药物治疗戒烟的临床疗效。联合戒烟疗效优于单药戒烟，主要与抑制吸烟渴望相关。
（林江涛 审校）
J Consult Clin Psychol. 2011 Nov 21. [Epub ahead of print]
Why two smoking cessation agents work better than one: Role of craving suppression.
Bolt DM, Piper ME, Theobald WE, Baker TB.
Abstract
OBJECTIVE: This research examined why smokers receiving combination medication for smoking cessation are more likely to quit smoking than are those who receive either single agent (monotherapy) or placebo.
METHOD: Data were collected from 1,504 current smokers (58.2% women, 83.9% White; mean age = 44.67 years, SD = 11.08) participating in a cessation clinical trial who were randomized to 1 of 6 cessation pharmacotherapy conditions (placebo, nicotine patch, nicotine lozenge, bupropion, nicotine patch + nicotine lozenge, and bupropion + nicotine lozenge). Participants completed ecological momentary assessments 4 times a day, concerning 5 hypothesized mediators (negative affect, positive affect, craving, smoking expectations, and withdrawal) of pharmacotherapy effects. Medications were provided for 8-12 weeks post-quit along with 6 individual counseling sessions. Mediational paths were estimated via a novel Bayesian approach with estimation of multiple mediator models.
RESULTS: Biochemically confirmed 8-week abstinence was the outcome variable, with the monotherapy and combination pharmacotherapy composites producing 45% (n = 689) and 54% (n = 478) abstinence rates, respectively. The univariate models suggested that the combination treatments produced higher abstinence rates than the monotherapies because of greater suppression of withdrawal, craving, and smoking expectations. However, multiple mediator models showed that the suppression of craving on the quit day produced the strongest mediational effects and could account for the mediational effects of other tested variables.
CONCLUSION: Suppression of craving on the quit day significantly mediates the clinical effects of monotherapies and combination smoking pharmacotherapies, and the higher abstinence rates for combination therapy versus monotherapies appear primarily due to greater craving suppression.
J Consult Clin Psychol. 2011 Nov 21. [Epub ahead of print]
目的：与单药或安慰剂戒烟的吸烟者相比，为什么联合药物戒烟的吸烟者更有可能戒烟。
方法：数据收集于参与戒烟临床试验的1504名吸烟者（58.2%的女性，83.9%的白人，平均年龄为44.67±11.08岁）。这些参与者随机分为6组，接受不同的戒烟治疗（安慰剂、尼古丁贴剂、尼古丁锭剂、安非他酮、尼古丁贴剂+尼古丁锭剂和安慰她同+尼古丁锭剂）。参与者完成每日4次的生态瞬时评估，关注5个药物治疗的假设的调节因素（负面影响，正面影响，渴望，吸烟期望和撤退症状）。治疗在戒烟后仍持续8～12周，其中进行6次个体咨询。采用新的贝叶斯方法，通过多重中介模型来估计中介路径。
结果：生化方法确定的8周戒断为主要的转归指标，单药和联合戒烟的戒断率分别为45%（n = 689）和54%（n = 478）。单变量模型分析显示，与单药戒烟相比，联合用药戒烟具有更高的戒断率，这与其抑制撤退症状、吸烟渴望和吸烟期望相关。然而，多重中介模型显示，戒烟日抑制吸烟渴望能产生最强的中介作用，是其他检测指标中介作用的原因。
结论：抑制戒烟日的吸烟渴望明显介导了单药和联合药物治疗戒烟的临床疗效。联合戒烟疗效优于单药戒烟，主要与抑制吸烟渴望相关。
（林江涛 审校）
J Consult Clin Psychol. 2011 Nov 21. [Epub ahead of print]
Why two smoking cessation agents work better than one: Role of craving suppression.
Bolt DM, Piper ME, Theobald WE, Baker TB.
Abstract
OBJECTIVE: This research examined why smokers receiving combination medication for smoking cessation are more likely to quit smoking than are those who receive either single agent (monotherapy) or placebo.
METHOD: Data were collected from 1,504 current smokers (58.2% women, 83.9% White; mean age = 44.67 years, SD = 11.08) participating in a cessation clinical trial who were randomized to 1 of 6 cessation pharmacotherapy conditions (placebo, nicotine patch, nicotine lozenge, bupropion, nicotine patch + nicotine lozenge, and bupropion + nicotine lozenge). Participants completed ecological momentary assessments 4 times a day, concerning 5 hypothesized mediators (negative affect, positive affect, craving, smoking expectations, and withdrawal) of pharmacotherapy effects. Medications were provided for 8-12 weeks post-quit along with 6 individual counseling sessions. Mediational paths were estimated via a novel Bayesian approach with estimation of multiple mediator models.
RESULTS: Biochemically confirmed 8-week abstinence was the outcome variable, with the monotherapy and combination pharmacotherapy composites producing 45% (n = 689) and 54% (n = 478) abstinence rates, respectively. The univariate models suggested that the combination treatments produced higher abstinence rates than the monotherapies because of greater suppression of withdrawal, craving, and smoking expectations. However, multiple mediator models showed that the suppression of craving on the quit day produced the strongest mediational effects and could account for the mediational effects of other tested variables.
CONCLUSION: Suppression of craving on the quit day significantly mediates the clinical effects of monotherapies and combination smoking pharmacotherapies, and the higher abstinence rates for combination therapy versus monotherapies appear primarily due to greater craving suppression.
J Consult Clin Psychol. 2011 Nov 21. [Epub ahead of print]
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有戒烟意愿人群中金雀花碱和尼古丁替代治疗的非劣效性试验的研究方案
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