Hočevar-Boltežar Irena, Matičič Mojca, Sereg-Bahar Maja, Gale Nina, Poljak Mario, Kocjan Boštjan, Zargi Miha
Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Ljubljana, Zaloška 2, 1000, Ljubljana, Slovenia,
Eur Arch Otorhinolaryngol. 2014 Dec;271(12):3255-62. doi: 10.1007/s00405-014-3143-y. Epub 2014 Jun 26.
In the case of an aggressive course of recurrent respiratory papillomatosis (RRP), adjuvant therapy can be used besides surgery. The aim of the study was to investigate the influence of vaccination with a quadrivalent vaccine against human papilloma viruses (HPV) types 6, 11, 16 and 18 on the course of RRP. Eleven subjects aged 13-46 years with a rapid growth of laryngeal papillomas were included in the study. They were vaccinated with three doses of the quadrivalent prophylactic HPV vaccine (Silgard(®), MSD) and followed up for 12-52 months. The intervals between the successive surgical procedures, the extension of the disease (Derkay score) at each surgery, and the number of surgical procedures per year before vaccination and after its completion were compared. The mean interval between the surgical procedures was 271.2 days before the vaccination and 537.4 days after it (p = 0.034). The mean number of surgeries per year was 2.16 before the vaccination and 0.93 after it (p = 0.022). The Derkay score did not change significantly after vaccination. Complete remission of the disease was observed in one patient, partial response to the vaccination was observed in seven patients and no response was observed in three patients. In conclusion, vaccination with the quadrivalent HPV vaccine can favorably influence the course of RRP in patients with the rapid growth of the papillomas. It significantly prolongs the intervals between the surgical procedures and reduces the number of procedures needed in the majority of patients. The present investigation can serve as a pilot study for further research. For a final conclusion a longer follow-up and studies on more patients are necessary.
对于复发性呼吸道乳头状瘤病（RRP）的侵袭性病程，除手术外还可采用辅助治疗。本研究的目的是调查接种针对6、11、16和18型人乳头瘤病毒（HPV）的四价疫苗对RRP病程的影响。11名年龄在13 - 46岁、喉乳头状瘤生长迅速的受试者被纳入研究。他们接种了三剂四价预防性HPV疫苗（希瑞适（®），默沙东公司），并随访12 - 52个月。比较了连续手术之间的间隔时间、每次手术时疾病的扩展情况（德凯评分）以及接种疫苗前和完成接种后每年的手术次数。接种疫苗前手术之间的平均间隔时间为271.2天，接种后为537.4天（p = 0.034）。接种疫苗前每年的平均手术次数为2.16次，接种后为0.93次（p = 0.022）。接种疫苗后德凯评分没有显著变化。1例患者疾病完全缓解，7例患者对疫苗有部分反应，3例患者无反应。总之，接种四价HPV疫苗可对乳头状瘤生长迅速的RRP患者的病程产生有利影响。它显著延长了手术间隔时间，并减少了大多数患者所需的手术次数。本研究可作为进一步研究的初步研究。要得出最终结论，需要更长时间的随访和对更多患者的研究。
