Sniffin’Sticks嗅觉心理物理测试方法的临床应用

Clinical application of Sniffin＇ Sticks olfactory psychophysical measurements

目的建立Sniffin’Sticks检查的中国人正常参考值，探讨其在我国临床应用的可行性。方法2007年至2013年于首都医科大学附属北京同仁医院体检科，任意选取健康志愿者105例作为健康对照组，任意选取同期该院耳鼻咽喉头颈外科门诊嗅觉障碍患者165例作为试验组，其中嗅觉功能减退组92例，嗅觉功能丧失组73例。对270例受试者又分别分为青年组（〈35岁）、中年组（-55岁）和老年组（〉55岁）3个亚组，分别采用Sniffin’Sticks和T＆T方法进行嗅觉功能检查。以SPSS12．0统计软件对数据结果进行分析。结果Sniffin’Sticks正常参考值是：青年组TDI值（气味阈值T、气味辨别阈值D和气味识别阈值I，三项得分之和）〉30．12，中年组TDI值〉27．37，老年组TDI值〉20．43；健康对照组TDI平均（x±s）值为32．12±3．95，嗅觉功能减退组TDI平均值17．52±10．37，嗅觉功能丧失组TDI平均值3．56±3．49。嗅觉功能减退和嗅觉功能丧失组和健康对照组按照青年、中年和老年各亚组分别比较，TDI值、阈值、辨别阈和识别阈差异均有统计学意义（青年组：F_TDI=125．136，F_T=49．454，F_D=89．037，F_I=39．888，P值均为0．000；中年组：F_TDI=190．240，F_T=128．374，F_D=174．122，F_I=178．945，P值均为0．000；老年组：F_TDI=72．992，F_T=26．599，F_D=77．119，F_I=88．107，P值均为0．000）。T＆T嗅觉识别阈结果显示，健康对照组平均值为-1．00±0．98，嗅觉功能减退组为2．27±2．01，嗅觉功能丧失组为5．89±0．14。嗅觉功能减退和丧失组与健康对照组按照青年、中年和老年各亚组分组比较差异均有统计学意义（F青年=158．144，F中年247．695，F老年=70．579，P值均为0．000）。Sniffin’Sticks检查结果中的TDI值与T＆T嗅觉识别阈值呈负相关（r=-0．927，P〈0．01）。T＆T识别阈值与Sniffin’Sticks阈值呈负相关（rT=-0．846，P〈0．01）；与辨别阈呈负相关（rD=-0．908，P〈0．01）；与识别阂呈负相关（rI=-0．864，P〈0．01）。结论Sniffin’Sticks嗅觉检测方法均能很好地区分嗅觉功能正常、减退和丧失，其测试结果与T＆T测试存在-致性，Sniffin’Sticks方法能多方面评价受试者的嗅觉功能状态，可以在中国人群中使用。

Objectives To establish the normal value of Sniffin＇ Sticks test in Chinese population and to explore it＇s clinical application in China. Methods One hundred and five healthy volunteers were choosen from the department of physical examination of Beijing Tongren Hospital between 2007 and 2013. Another 165 patients complained of abnormal olfactory function were obtained from the outpatient clinic of the department of otorhinolaryngology head and neck surgery in the same period and were divided into two groups ：92 in hyposmia and 73 in functional anosmia group. The 270 subjects were divided into 3 subgroups： younger group（ 〈35 years of age）, middle-age group（35 -55 years of age） and older group（ 〉55 years of age）. The olfactory functions were examined with Sniffin＇ Sticks test and T＆T test, respectively. All analyseswere performed using SPSS 12.0 software. Results For the normal value of Sniffin＇ Sticks test, TDI score was 〉 30. 12 for younger group, 〉 27.37 for middle-age group and 〉 20.43 for older group ; the mean TDI score was 32. 12 ± 3.95 for healthy group, 17. 52 ± 10. 37 for hyposmia and 3.56 ± 3.49 for functional anosmia group; the differences in TDI score, olfactory threshold, discrimination threshold and identification threshold between healthy group and olfactory dysfunction group with different ages had statistical significance （Younger group： FTDI = 125. 136, P = 0. 000; FT = 49. 454, P = 0. 000; FD = 89. 037, P = 0. 000; FI = 39. 888, P = 0. 000 ; Middle-age group ： FTDI = 190. 240, P = 0. 000 ; FT = 128. 374, P = 0. 000 ; FD = 174. 122, P = 0. 000 ; FI = 178. 945, P = 0. 000 ; Older group ： FTDI = 72. 992, P = 0. 000 ; FT = 26. 599, P = 0. 000 ; FD = 77. 119 ,P =0. 000;FI = 88. 107, P = 0. 000, respectively）. The mean T＆T value was - 1.00 ± 0. 98 for healthy group, 2. 27± 2. 01 for hyposmia and 5.89± 0. 14 for functional anosmia group. T＆T score between healthy group and olfactory dysfunction group with different ages had statistical significance （Fyounger = 158. 144, P = 0. 000; Fmiddle-age = 247. 695, P = 0. 000; Folder = 70. 579, P = 0. 000, respectively）. TDI score of the Sniffin＇ Sticks test result was correlated with T＆T value （ r = - 0. 927, P 〈 0. 01 ） ; T＆T threshold was correlated with the olfactory threshold, discrimination threshold and identification threshold of Sniffin＇ Sticks test （rT = -0.846, P 〈0.01, rD = -0.908 P 〈0.01, rI = -0.864, P 〈0.01, respectively）. Conclusions Sniffin＇ Sticks test and T＆T olfaetometry are able to differentiate normosmia from hyposmia and anosmia with high reliability and consistency in test results. Sniffin＇ Sticks test can assess subject＇s olfactory function status more thoroughly and is suitable for application in Chinese population.