Bitar Mohamed, Baz Rami, Fuleihan Nabil, Muallem Musa
Section of Pediatric Otolaryngology, Department of Otolaryngology-Head & Neck Surgery, American University of Beirut and Medical Center, Beirut, Lebanon.
Int J Pediatr Otorhinolaryngol. 2007 Aug;71(8):1163-73. doi: 10.1016/j.ijporl.2007.05.008. Epub 2007 Jun 8.
To report a severe case of juvenile onset recurrent respiratory papillomatosis (JORRP) controlled by zinc replacement therapy. To review the contemporary adjuvant therapies used in JORRP.
The trial of zinc was described in terms of its effect on the inter-surgical interval, site score and clinical symptoms. Long-term follow-up with dose adjustment was detailed. Articles reporting trials of adjuvant therapies over the past 20 years were reviewed in terms of regimen used, mode of assessment, side effects and final outcome.
Zinc was effective in decreasing the severity of the disease, the rate of relapse and the need for surgery. There was an obvious relation between the dose used and the degree of improvement. Prolonged treatment seems to be needed to sustain the positive effect. No side effects were noticed over a 45-month follow-up period. The literature does support the role of zinc in modulating the immune system. Eight adjuvant therapies were reviewed as published in 40 reports. Interferon was the most used substance. It is definitely effective but often associated with relapse upon discontinuation. The effect of cidofovir was favorable yet not dramatic as initially expected. Other less commonly used therapies showed humble effects. The HspE7 vaccine seems to be promising awaiting further trials.
Zinc replacement therapy may benefit JORRP patients with zinc deficiency and should be investigated in more cases. Several adjuvant therapies are available for use in JORRP. They are generally beneficial though mostly not curative.
报告一例通过补锌治疗得到控制的青少年复发性呼吸道乳头状瘤病（JORRP）重症病例。回顾JORRP目前使用的辅助治疗方法。
描述了锌对手术间隔时间、病变部位评分及临床症状的影响试验。详细介绍了进行剂量调整的长期随访情况。对过去20年报道辅助治疗试验的文章，从所用治疗方案、评估方式、副作用及最终结果方面进行了综述。
锌在降低疾病严重程度、复发率及手术需求方面有效。所用剂量与改善程度之间存在明显关联。似乎需要延长治疗以维持积极效果。在45个月的随访期内未发现副作用。文献确实支持锌在调节免疫系统方面的作用。对40篇报告中发表的8种辅助治疗方法进行了综述。干扰素是最常用的药物。它肯定有效，但停药后常伴有复发。西多福韦的效果良好，但不像最初预期的那么显著。其他较少使用的治疗方法效果一般。HspE7疫苗似乎很有前景，有待进一步试验。
补锌治疗可能使缺锌的JORRP患者受益，应在更多病例中进行研究。有几种辅助治疗方法可用于JORRP。它们通常有益，但大多无法治愈。
