2019冠状病毒疾病相关嗅觉障碍

Advances in anosmia and olfactory dysfunction of patients with COVID-19

2019冠状病毒疾病(COVID-19)的致病病毒为新型冠状病毒SARS-CoV-2,其主要临床表现为发热、干咳、乏力等上呼吸道感染症状,严重者可快速进展为急性呼吸窘迫综合征、脓毒症休克、难以纠正代谢性酸中毒和出凝血功能障碍及多器官功能衰竭等。多国流行病学研究调查表明嗅觉障碍是COVID-19的临床症状之一,甚至是部分COVID-19患者的首发症状,其在COVID-19的早期诊断及临床筛查中具有重要意义。本文通过对COVID-19所致嗅觉障碍流行病学、预后及发病机制进行综述,结果显示嗅觉障碍多发生于COVID-19轻症患者,且预后较好。现阶段有关COVID-19所致嗅觉障碍发病机制尚不明确,现推测与其他呼吸道病毒感染后出现的嗅觉障碍的机制相类似,因鼻腔黏膜肿胀导致的传导性嗅觉障碍,或因病毒直接损伤嗅上皮甚至嗅觉通路的更高层面而导致感觉神经性嗅觉障碍,血管紧张素转换酶2(ACE2)和II型跨膜丝氨酸蛋白酶(TMPRSS 2)基因在其中发挥重要作用。

The Novel Coronavirus Disease 2019(COVID-19)is caused by severe acute respiratory syndrome(SARS)coronavirus 2(SARS-CoV-2)with main clinical manifestations of fever,dry cough,fatigue and other symptoms of upper respiratory tract infection.Severe patients have a rapidly progress of SARS,septic shock,metabolic acidosis difficultly to be corrected,coagulation dysfunction and multiple organ failure,etc.Epidemiological investigations in many countries have shown that olfactory dysfunction is one of the clinical symptoms of COVID-19,and even the initial symptom of some patients with COVID-19.This phenomenon indicates that the olfactory dysfunction plays an important role in the early diagnosis and clinical screening of COVID-19.This paper reviewed the epidemiology,prognosis and pathogenesis of olfactory disorders caused by COVID-19.The results showed that olfactory disorders mostly occurred in mild covid-19 patients,who had a good prognosis.At present,the pathogenesis of olfactory dysfunction caused by COVID-19 is still unclear.It is speculated that the mechanism of olfactory dysfunction caused by COVID-19 is similar to that of other respiratory viruses.It may be caused by nasal mucosa swelling,directly a virus damage to olfactory epithelium or olfactory pathway with a disorders of sensorineural smell,among which ACE2 and TMPRSS 2 might play an important role.