抽象的
与可能自发退缩的简单幼年喉乳头瘤相比,涉及肺实质的乳头状瘤病与结果不佳有关。
该报告代表了一名34岁女性的情况,其中呼吸乳头状瘤病导致语音问题和由于支气管阻塞引起的复发性肺炎。胸部的计算机断层扫描显示双侧圆形固结恶化。支气管镜检查显示右声带和中部导管的息肉样病变被组织学证实为鳞状乳头状瘤病。
Interferon (IFN)α-2b treatment was inefficient as was cidofovir monotherapy on a maintenance basis. Six months of IFN-α-2b and cidofovir in combination led to a complete macroscopic disappearance of the laryngeal lesions and to an impressive regression of the tracheal papillomas and of the intrapulmonary consolidations.
这些数据提供了支持,即可以通过干扰素α-2b和Cidofovir安全治疗严重的呼吸乳头瘤病。在这种情况下,在慢性丙型肝炎患者中,在利巴韦林加干扰素α-2B中可能具有相同的机制,在这种情况下是造成治疗成功的原因。
由人乳头瘤病毒(HPV)引起的呼吸乳头瘤病是一种罕见但通常是严重的疾病。良性上皮增殖可能导致气道障碍,导致呼吸道的慢性变化1,2。治疗通常基于病变的手术消融,通常使用二氧化碳激光器2。Intralesional application of cidofovir [(S)−1-(3-hydroxy-2-phosphonylmethoxypropyl) cytosine] was recently reported to be successful in laryngeal papillomatosis, but treatment of endobronchial and intrapulmonary lesions has not been studied1–3。
案例报告
1997年,一名34岁的妇女因呼吸乳头瘤病而被送往我们的医院。自从她已经7岁以来,她已经经历了200多个微咽镜,并且由于支气管阻塞而患有声音问题和反复发作的肺炎。干扰素α-2b处理(5×106单位每周三次)在30岁时建立了,但频繁的复发仍然是一个问题。
A computed tomographic scan of the chest showed bilateral round cavitating consolidations which worsened during the subsequent 18 months after admission (fig. 1×)。总体麻醉下的支气管镜检查于1997年4月首次进行,并揭示了右声带和中导管的息肉病变。气管和喉活检标本的组织学证实了鳞状乳头瘤菌病的诊断。使用聚合酶链反应(Hybrid Capture II测试,Digene Corp.,MD,美国马里兰州)进行了6型和11型HPV。
Computed tomographic scans of the chest. a, b) Bilateral round cavitating consolidations (October 1997); c) Marked response of the intrapulmonary consolidations due to cidofovir/interferon α−2b combination therapy (December 1999).
在1997年至1998年10月之间,该患者用氩激光蒸发治疗了两次。IFN-α-2B治疗一直持续到1998年10月,当时患者再次被人声线的大息肉鳞状乳头瘤和涉及气管的圆周多息肉肿瘤入院(图2×)。基于这些内窥镜检查结果,由于缺乏疗效和Cidofovir治疗,IFN-α-2B治疗被停止了(诱导治疗:5 mg·Kg·kg−1bodyweight once a week during two weeks, maintenance treatment: 5 mg·kg−1每2周重一次体重)。1998年12月的内窥镜控制显示了喉乳头瘤的消退,但有证据表明气管中乳头状瘤病变正在进行(图2×)。
Regression of squamous papillomas of the larynx and the midtrachea following treatment. a) Laryngeal papillomas – the picture was taken during the second bronchoscopy (October 1998); b) Regression of laryngeal papillomas under cidofovir/ interferon α−2b combination therapy; c) Complete macroscopic disappearance of laryngeal papillomas after 6 months of combination therapy; d) Circumferential polypoid tumour involving the trachea (October 1998); e) Marked response of the papillomas in the trachea after 6 months of cidofovir/interferon α−2b combination therapy; f) Further regression of the papillomatous lesions involving the trachea.
Due to recurrence of papillomatosis in the larynx, IFN-α-2b was added to cidofovir. Six months of this combination therapy led to a complete macroscopic disappearance of the laryngeal lesions and to a marked response of the papillomas in the trachea (fig. 2⇑)。A computed tomographic scan of the chest in December 1999 showed no evidence of endobronchial lesions and an impressive regression of the intrapulmonary consolidations (fig. 1⇑)。
以给定剂量(5 mg·kg)−1每两周体重)cidofovir耐受性良好,在12个月的治疗期间无法检测到造血性,肾毒性或肝毒性。
Discussion
呼吸乳头瘤病的过程是可变的。与可能自发退缩的简单幼年喉乳头瘤相比,涉及肺实质的乳头状瘤病与结果不佳有关4。肿瘤内注射CIDOFOVIR的作用打开了HPV诱导的病变的观点,可容易用于注射疗法,但支气管内和肺内病变代表了治疗困境1–3。
普兰斯基et al.2recently described a dramatic response of papillomatous lesions to intralesional cidofovir and IFN-α−2a in a child. To the best of the authors' knowledge, the efficacy of this treatment regimen in adult respiratory papillomatosis involving pulmonary parenchyma has not been reported at the time of our study.
本文提供的数据提供了支持,即在维持的基础上与Cidofovir结合疗法,干扰素α-2B在成人呼吸乳头虫病中有效。利巴韦林加干扰素-α-2B在治疗慢性丙型肝炎患者中涉及的相同机制可能是我们案例的治疗成功的原因5。
- 已收到2000年2月21日。
- Accepted2000年8月7日。
- © ERS Journals Ltd.