戒菸行動對降低愛滋病毒感染者罹患冠心病風險之評估

Smoking Cessation Program for People Who are Living with HIV may Reduce Risk Score for Coronary Heart Disease

目的：由於高效能抗病毒藥物的進步，愛滋病毒感染者已能有效延長壽命，然而卻有比一般大眾為高的抽菸盛行率。因此推動愛滋感染者加入戒菸計畫，透過戒菸衛教與弗萊明漢冠心病風險評估(Framingham Risk Score)，改變抽菸行為。方法：在2015年，桃園某醫院的門診就醫的愛滋病毒感染者，在簽署知情同意書後，收集資料第一、調查抽菸現況；第二、紀錄年齡，性別，血壓，糖尿病史，吸煙現狀，總膽固醇和高密度脂蛋白數值、及服藥現況；第三、計算其冠心病風險評分。然後追蹤三年。同意戒菸者，持續2-4個月的兩周一次戒菸門診、衛教及評估；全部個案持續每三個月門診追蹤乙次，觀察直至2018年12月。結果：總共招募152名受試者。其中139人(91.5%)為男性，47名加入戒菸組，38名是持續抽菸組，67名是未抽菸組。戒菸組有17%、持續抽菸組有5.3%、未抽菸組有7.5%呈現中度(6至9分)冠心病風險分數；且戒菸組有4.3%有高度(10分以上)冠心病風險分數。冠心病風險分數在追蹤三年後再度評估，戒菸組有顯著下降(從3.70到2.28，p<0.005)，持續抽菸組有顯著增加(從-0.16到1.79，p<0.005)、未抽菸組則無明顯變化(從-0.14至-0.06，p=0.49)。冠心病風險總分數戒菸組在3年後下降了38% (從174到107)；反之，持續抽菸組增加了12倍。結論：戒菸能減少冠心病風險。對愛滋病毒感染者，鼓勵戒菸是必要的健康促進措施。

Objectives. People who are living with HIV (PLHIV) can now live longer due to the development and availability of highly active antiretroviral therapy. However, there is a higher prevalence of active smoking among them. In this study, we uses the Framingham risk score (FRS) tool to evaluated risk of coronary heart disease among a group of PLHIV and provided them with a smoking cessation program.
Methods. After obtaining informed consent, we collected their descriptive data, including ages, genders, blood pressure, history of diabetes mellitus, current status of smoking, level of total cholesterol (T-CHO), and level of high-density lipoprotein (HDL). FRS were calculated (low risk score: 1-5, moderate risk score: 6-9, high risk score: 10 or above). All the subjects were followed up for 3 years between 2015 and 2018.
Results. A total of 152 subjects were recruited. Of these, 139 (91.5%) were male. Forty-seven 47 subjects joined the cessation (SC) group, 38 belonging to a subgroup who fully participated in the program from beginning to end, the uninterrupted (SU) group. Sixty-seven subjects categorized into a non-smoking (NS) group. Moderate risk was noted in 17% in the SC group, 5.3% in the SU group, and 7.5% in the NS group. And 4.3% of SC group were at high risk. At 3-year follow up, FRS showed a significant decrease in risk in the SC group (from 3.70 to 2.28, p<0.005), and an increase (-0.16 to 1.79, p<0.005) in the SU group. The change of NS group was not significant (-0.14 to -0.06, p=0.49). Accumulated FRS had 38% of decrease (from 174 to 107) during these 3 years after smoking cessation program in SC group. On the contrary, there was 12-fold increase in FRS in the SU group.
Conclusion. Tobacco cessation may decrease the risk of coronary heart disease. Smoking cessation programs should be promoted among PLHIV to help improve their quality of life and health.