近日，英国约克大学Kamran Siddiqi团队研究了移动健康干预对结核病患者戒烟的疗效。2025年12月22日，《美国医学会杂志》发表了这一成果。

吸烟会恶化结核病患者的预后，而戒烟则会加速康复。

该研究旨在评估移动健康（mHealth）干预措施在6个月时实现自我报告的持续戒烟的有效性，并在6个月时进行生化验证，与结核病患者的常规治疗进行比较。2023年9月18日至2025年1月2日，研究组进行了多中心、集群随机临床试验，将孟加拉国和巴基斯坦的27家结核病诊所随机（2:1）分配到移动健康组或常规护理组。随访6个月。如果参与者年龄在15岁或以上，在过去4周内被诊断患有药物敏感性肺结核，每天吸烟，愿意戒烟，并且可以使用手机，则符合条件。

mHealth组(n=720)在结核病治疗期间每天收到短信，持续2个月，然后每月收到短信，持续4个月，鼓励戒烟。常规护理组(n=360)收到了关于戒烟的书面资料。主要结局是6个月时自我报告的持续戒断，6个月时使用一氧化碳呼吸测试进行生化验证。次要结局包括自我报告的9周和6个月时的点戒断、结核病治疗依从性（接受结核病治疗的天数）、结核病治疗成功(治愈+完成治疗)、结核病治疗失败、结核病治疗默认（结核病治疗中断≥2个月）和死亡。

在9232例评估合格的患者中，1080例是随机的；大多数是男性（移动健康，96.9%；常规护理，95.8%），在整个试验中保留了985名（91%）。对于主要结局，移动健康组720名参与者中有300名（41.7%）在6个月时表现出自我报告和生化验证的持续戒烟，而常规护理组360名参与者中有55名（15.3%）（风险比为3.0）。在移动健康组与常规护理组中，平均结核病治疗依从性分别为174.3 （SD, 21.5）天和178.0 （SD, 12.1）天。治疗成功率为89.3% vs 85.6%（风险比为1.2）。结核病治疗失败（0.1%对0.5%）和复吸（3.1%对1.9%）并不常见。移动医疗的死亡率（3.5%）低于常规护理（7.5%）（风险比0.4）。

研究结果表明，移动健康干预在实现吸烟的结核病患者持续戒烟方面是有效的。移动医疗是帮助结核病患者戒烟的一种可行而有效的干预手段。

附：英文原文

Title: An mHealth (Mobile Health) Intervention for Smoking Cessation in People With Tuberculosis: A Cluster Randomized Clinical Trial

Author: Maham Zahid, Fahmidur Rahman, Mahmoud Danaee, Shakhawat Hossain Rana, Asiful Chowdhury, Saeed Ansaari, Ai Keow Lim, Melanie Boeckmann, Steve Parrott, Jinshuo Li, Amina Khan, Rumana Huque, John Norrie, Kamran Siddiqi

Issue&Volume: 2025-12-22

Abstract:

Importance  Smoking worsens outcomes in people with tuberculosis (TB), while quitting hastens recovery.

Objective  To assess the effectiveness of a mobile health (mHealth) intervention for achieving self-reported continuous tobacco abstinence at 6 months, supported by biochemical verification at 6 months, compared with usual care in people with TB.

Design, Setting, and Participants  Multicenter, cluster randomized clinical trial conducted between September 18, 2023, and January 2, 2025, randomizing (2:1) 27 TB clinics in Bangladesh and Pakistan to mHealth or usual care groups. The follow-up was 6 months. Participants were eligible if they were 15 years or older, had been diagnosed with drug-sensitive pulmonary TB in the past 4 weeks, smoked daily, were willing to quit, and had access to mobile phones.

Intervention  The mHealth group (n=720) received text messages throughout TB treatment, daily for 2 months then monthly for 4 months, encouraging tobacco cessation. The usual care group (n=360) received written information on tobacco cessation.

Main Outcomes and Measures  The primary outcome was self-reported continuous abstinence at 6 months, verified biochemically using carbon monoxide breath test at 6 months. Secondary outcomes included self-reported point abstinence at 9 weeks and 6 months, TB treatment adherence (days receiving TB treatment), TB treatment success (cured+completed treatment), TB treatment failure, TB treatment default (interruption of TB treatment for ≥2 months), and death.

Results  Of 9232 patients assessed for eligibility, 1080 were randomized; most were male (mHealth, 96.9%; usual care, 95.8%), and 985 were retained throughout the trial (91%). For the primary outcome, 300 of 720 participants (41.7%) in the mHealth group demonstrated self-reported and biochemically verified continuous abstinence at 6 months, compared with 55 of 360 (15.3%) in the usual care group (risk ratio, 3.0 [95% CI, 2.0-4.9]). In the mHealth vs usual care groups, respectively, mean TB treatment adherence was 174.3 (SD, 21.5) days vs 178.0 (SD, 12.1) days (P=.23), and treatment success was 89.3% vs 85.6% (risk ratio, 1.2 [95% CI, 0.9-1.6]). TB treatment failure (0.1% vs 0.5%) and default (3.1% vs 1.9%) were uncommon. Mortality was lower with mHealth (3.5%) vs usual care (7.5%) (hazard ratio, 0.4 [95%CI, 0.2-0.9]).

Conclusions and Relevance  An mHealth intervention was effective in achieving continuous abstinence in people with TB who smoked. mHealth is a feasible and effective intervention to help patients with TB quit smoking.

DOI: 10.1001/jama.2025.20765

Source: https://jamanetwork.com/journals/jama/fullarticle/2843169