El Dib Regina, Suzumura Erica A, Akl Elie A, Gomaa Huda, Agarwal Arnav, Chang Yaping, Prasad Manya, Ashoorion Vahid, Heels-Ansdell Diane, Maziak Wasim, Guyatt Gordon
Department of Anaesthesiology, Botucatu Medical School, UNESP-Univ Estadual Paulista, São Paulo, Brazil.
McMaster Institute of Urology, McMaster University, Hamilton, Ontario, Canada.
BMJ Open. 2017 Feb 23;7(2):e012680. doi: 10.1136/bmjopen-2016-012680.
A systematic review and meta-analysis to investigate the impact of electronic nicotine delivery systems (ENDS) and/or electronic non-nicotine delivery systems (ENNDS) versus no smoking cessation aid, or alternative smoking cessation aids, in cigarette smokers on long-term tobacco use.
Searches of MEDLINE, EMBASE, PsycInfo, CINAHL, CENTRAL and Web of Science up to December 2015.
Randomised controlled trials (RCTs) and prospective cohort studies.
Three pairs of reviewers independently screened potentially eligible articles, extracted data from included studies on populations, interventions and outcomes and assessed their risk of bias. We used the Grading of Recommendations Assessment, Development and Evaluation approach to rate overall certainty of the evidence by outcome.
Three randomised trials including 1007 participants and nine cohorts including 13 115 participants proved eligible. Results provided by only two RCTs suggest a possible increase in tobacco smoking cessation with ENDS in comparison with ENNDS (RR 2.03, 95% CI 0.94 to 4.38; p=0.07; I=0%, risk difference (RD) 64/1000 over 6 to 12 months, low-certainty evidence). Results from cohort studies suggested a possible reduction in quit rates with use of ENDS compared with no use of ENDS (OR 0.74, 95% CI 0.55 to 1.00; p=0.051; I=56%, very low certainty).
There is very limited evidence regarding the impact of ENDS or ENNDS on tobacco smoking cessation, reduction or adverse effects: data from RCTs are of low certainty and observational studies of very low certainty. The limitations of the cohort studies led us to a rating of very low-certainty evidence from which no credible inferences can be drawn. Lack of usefulness with regard to address the question of e-cigarettes' efficacy on smoking reduction and cessation was largely due to poor reporting. This review underlines the need to conduct well-designed trials measuring biochemically validated outcomes and adverse effects.
进行一项系统评价和荟萃分析，以研究电子尼古丁传送系统（ENDS）和/或电子非尼古丁传送系统（ENNDS）与无戒烟辅助工具或其他戒烟辅助工具相比，对吸烟者长期烟草使用的影响。
检索截至2015年12月的MEDLINE、EMBASE、PsycInfo、CINAHL、CENTRAL和科学引文索引数据库。
随机对照试验（RCT）和前瞻性队列研究。
三对评审员独立筛选可能符合条件的文章，从纳入研究中提取有关人群、干预措施和结局的数据，并评估其偏倚风险。我们采用推荐分级评估、制定与评价方法，按结局对证据的总体确定性进行评级。
三项随机试验（包括1007名参与者）和九项队列研究（包括13115名参与者）被证明符合条件。仅两项随机对照试验的结果表明，与电子非尼古丁传送系统相比，使用电子尼古丁传送系统戒烟的可能性可能增加（风险比2.03，95%置信区间0.94至4.38；p=0.07；I²=0%，6至12个月的风险差异为每1000人中有64人，低确定性证据）。队列研究结果表明，与不使用电子尼古丁传送系统相比，使用该系统可能会降低戒烟率（优势比0.74，95%置信区间0.55至1.00；p=0.051；I²=56%，极低确定性）。
关于电子尼古丁传送系统或电子非尼古丁传送系统对戒烟、减少吸烟或不良反应影响的证据非常有限：随机对照试验的数据确定性低，观察性研究的确定性极低。队列研究的局限性导致我们对证据的评级为极低确定性证据，无法从中得出可靠的推论。在解决电子烟对减少吸烟和戒烟效果问题方面缺乏实用性，很大程度上是由于报告不佳。本综述强调需要进行精心设计的试验，测量经过生化验证的结局和不良反应。
