上呼吸道感染后嗅觉障碍患者化学感觉功能评估

Evaluation of chemosensory function in patients with upper respiratory tract post-viral olfactory dysfunction

目的观察上呼吸道感染后嗅觉障碍(post-viral olfactory dysfunction,PVOD)患者的嗅觉功能、鼻内三叉神经功能和味觉功能变化,探讨PVOD患者化学感觉功能变化的相关性。方法回顾性分析2019年1—12月在北京安贞医院耳鼻咽喉头颈外科嗅觉味觉中心就诊的PVOD患者42例,其中男20例,女22例,年龄(48.86±11.47)岁(xˉ±s,后同)。根据PVOD患者性别比选取正常对照组受试者20例。对受试者进行Sniffin′Sticks嗅觉测试,包括察觉阈(threshold,T)、辨别能力(discrimination,D)和识别能力(identification,I)测试,3项测试得分总和为TDI值。同时对受试者进行嗅觉事件相关电位(olfactory event-related potentials,oERPs)、三叉神经事件相关电位(trigeminal event-related potentials,tERPs)检查和味觉功能测试。根据味觉功能测试结果将PVOD患者分为味觉功能正常(normal gustation,NG)组和味觉功能障碍(gustatory dysfunction,GD)组。比较不同组间的嗅觉、味觉、鼻内三叉神经功能检查结果,并进行相关分析。使用SPSS统计软件进行统计学分析。结果42例PVOD患者的病程为5(3,6)[M(Q_(1),Q_(3))]个月,其中14例(33.3%)患者伴有GD。PVOD患者的味觉功能与性别(r=0.565,P<0.001)、吸烟(r=-0.512,P=0.001)、嗅觉障碍病程(r=-0.357,P=0.020)和嗅觉功能(P值均<0.05)相关。GD组患者嗅觉功能较NG组患者差,其中两组间TDI值和T值的差异具有统计学意义[(10.25±4.58)分比(13.35±3.61)分,(1.54±0.66)分比(2.10±0.88)分,t=2.40、2.10,P值均<0.05]。GD组患者oERPs和tERPs的各波振幅明显低于NG组患者(P值均<0.05)。结论PVOD患者的主、客观嗅觉功能、鼻内三叉神经功能和味觉功能均有下降,并存在相关性,提示PVOD患者化学感觉功能间存在协同作用。

Objective To observe the changes of olfactory function,intranasal trigeminal nerve function and taste function in patients with upper respiratory tract post-viral olfactory dysfunction(PVOD),and to explore the correlation of chemosensory function.Methods The clinical data of 42 patients with PVOD who visited to the Olfactory and Taste Center of Otorhinolaryngology Head and Neck Surgery Department of Beijing Anzhen Hospital from January to December of 2019 were analyzed retrospectively,including 20 males and 22 females,aging(48.86±11.47)years(x¯±s).Twenty subjects in normal control group were selected according to the sex ratio of PVOD patients.Sniffin′Sticks olfactory tests were performed on the subjects,including threshold test(T),discrimination test(D)and identification test(I),and the sum of the above three test scores was the TDI value.At the same time,olfactory event-related potentials(oERPs),trigeminal event-related potentials(tERPs)and taste function test were performed.According to the taste function test,the patients were divided into normal gustation(NG)group and gustatory dysfunction(GD)group.The results of olfaction,taste and intranasal trigeminal nerve function tests were compared among different groups,and the correlation analysis was carried out.SPSS statistical software was used for statistical analysis.Results GD was present in 14(33.3%)of 42 PVOD patients with a course of PVOD of 5(3,6)months(M(Q_(1),Q_(3))).The gustatory function of patients with PVOD was related to gender(r=0.565,P<0.001),smoking status(r=-0.512,P=0.001),duration(r=-0.357,P=0.020)and olfactory function(all P<0.05).The olfactory function of GD group was worse than that of NG group,and the differences of TDI value and T value between the two groups were statistically significant(10.25±4.58 vs 13.35±3.61,1.54±0.66 vs 2.10±0.88,t value was 2.40 and 2.10 respectively,both P<0.05).The amplitudes of oERPs and tERPs were significantly lower in GD group than those in NG group(all P<0.05).Conclusion In patients with PVOD,the subjective and objective olfactory function,intranasal trigeminal nerve function and taste function were decreased,and there was a correlation,suggesting that there was a synergistic effect between the chemosensory functions of PVOD patients.