Department of Social and Preventive Medicine, Université de Montréal, Montréal, Québec, Canada.
J Med Virol. 2013 Aug;85(8):1447-58. doi: 10.1002/jmv.23615.
Juvenile recurrent respiratory papillomatosis is caused mainly by human papillomavirus genotypes 6 or 11, acquired at birth or during pregnancy from an infected mother. Recurrent respiratory papillomatosis is characterized by recurring warts growing most commonly in the larynx. Multiple surgical procedures and the risk of airway obstruction contribute to the devastating impact of this disease. Some children will go into remission after a few surgeries whereas others will require repeated interventions over several years. Further understanding of the risk factors associated with severity may contribute to tailored treatments. A retrospective study of cases diagnosed between January 1995 and December 2008 was conducted to study determinants of severe forms of juvenile recurrent respiratory papillomatosis. Demographic and clinical variables were abstracted from children's medical charts and mothers' delivery charts. Viral factors (HPV genotyping and viral load) were studied from archived biopsies. Specific HLA class II alleles and killer-cell immunoglobulin-like receptors genes were tested from saliva samples. Logistic regression was performed to identify risk factors for severity. Overall, 31 pediatric cases of recurrent respiratory papillomatosis were identified. The only significant factor associated with severe forms of recurrent respiratory papillomatosis was the maternal history of condylomas during pregnancy (OR: 12.05 [P=0.05]). The analysis failed to identify risk factors that could be used clinically to identify recurrent respiratory papillomatosis cases likely to take a severe course. Although too early to determine, vaccination against the HPV types involved most commonly in recurrent respiratory papillomatosis may provide the best hope to prevent severe forms of this disease.
儿童复发性呼吸道乳头瘤病主要由人乳头瘤病毒 6 型或 11 型引起，在出生时或怀孕期间从受感染的母亲那里获得。复发性呼吸道乳头瘤病的特征是经常在喉部生长的疣。多次手术和气道阻塞的风险导致了这种疾病的破坏性影响。一些儿童在几次手术后会缓解，而另一些儿童则需要在几年内反复干预。进一步了解与严重程度相关的危险因素可能有助于制定针对性的治疗方案。对 1995 年 1 月至 2008 年 12 月期间诊断的病例进行了回顾性研究，以研究儿童复发性呼吸道乳头瘤病严重形式的决定因素。从儿童病历和母亲分娩记录中提取人口统计学和临床变量。从存档的活检中研究病毒因素（HPV 基因分型和病毒载量）。从唾液样本中测试特定的 HLA Ⅱ类等位基因和杀伤细胞免疫球蛋白样受体基因。采用逻辑回归来确定严重程度的危险因素。总共发现 31 例复发性呼吸道乳头瘤病患儿。与复发性呼吸道乳头瘤病严重形式相关的唯一显著因素是母亲在怀孕期间患有湿疣的病史（比值比：12.05[P=0.05]）。该分析未能确定可用于临床识别可能出现严重病程的复发性呼吸道乳头瘤病病例的危险因素。尽管还为时过早，但针对复发性呼吸道乳头瘤病最常见的 HPV 类型进行疫苗接种可能是预防这种疾病严重形式的最佳希望。
