Hawkes Michael, Campisi Paolo, Zafar Rubeena, Punthakee Xerxes, Dupuis Annie, Forte Vito, Ford-Jones Elizabeth Lee
Division of Infectious Diseases, Hospital for Sick Children, Toronto, ON, Canada.
Pediatr Infect Dis J. 2008 Feb;27(2):149-54. doi: 10.1097/INF.0b013e318159833e.
With the recent licensure of a new quadrivalent vaccine, many diseases caused by human papillomavirus (HPV) can now be prevented, including recurrent respiratory papillomatosis (RRP). The purpose of this study was to describe the burden and time course of juvenile onset RRP.
A retrospective chart review was conducted of children with airway papillomatosis at the Hospital for Sick Children in Toronto, Canada, between 1994 and 2004. Statistical methods included descriptive statistics of the cohort, a repeated events survival model, and nonlinear modeling equations to describe the time course of illness.
Nine hundred twenty-six surgical procedures in 67 patients were identified through a review of surgical records. The median age at diagnosis was 3.2 years (range, 0.1-14.8 years) and the most common presenting symptom was hoarseness (75%). Adjuvant pharmacologic therapy (interferon or cidofovir) was used in 13 cases (19%). HPV types 6 or 11 were identified most commonly as the etiologic agent. Nonlinear modeling equations (exponential and quadratic) fit the observed data well, and were superior to linear models. Repeated events survival analysis identified significant prognostic variables: surgeon, adjuvant therapy, and anatomic score. A decision rule is presented that allows the time to next surgery to be predicted based on the previous surgery and the anatomic score.
Most patients have a decelerating rate of debulking surgeries over time, well described by our nonlinear modeling equations. Factors affecting the time course of RRP include: inter-surgeon variability, the extent and severity of papillomas at the time of laryngoscopy, and the use of adjuvant medical therapies.
随着一种新型四价疫苗的近期获批，许多由人乳头瘤病毒（HPV）引起的疾病现在可以得到预防，包括复发性呼吸道乳头瘤病（RRP）。本研究的目的是描述青少年期RRP的负担和病程。
对1994年至2004年期间加拿大多伦多病童医院患有气道乳头瘤病的儿童进行了回顾性病历审查。统计方法包括队列的描述性统计、重复事件生存模型以及用于描述疾病病程的非线性建模方程。
通过审查手术记录，在67例患者中确定了926次外科手术。诊断时的中位年龄为3.2岁（范围0.1 - 14.8岁），最常见的首发症状是声音嘶哑（75%）。13例（19%）使用了辅助药物治疗（干扰素或西多福韦）。最常鉴定出的HPV类型为6型或11型作为病原体。非线性建模方程（指数和二次方程）很好地拟合了观察数据，并且优于线性模型。重复事件生存分析确定了显著的预后变量：外科医生、辅助治疗和解剖学评分。提出了一个决策规则，可根据上一次手术和解剖学评分预测下一次手术的时间。
随着时间的推移，大多数患者的减瘤手术率呈下降趋势，我们的非线性建模方程对此有很好的描述。影响RRP病程的因素包括：外科医生之间的差异、喉镜检查时乳头瘤的范围和严重程度以及辅助药物治疗的使用。
