痉挛性斜颈嗅觉功能量化评估临床研究

Clinical study on quantitative evaluation of olfactory function in spastic torticollis

目的探讨痉挛性斜颈(spastic torticollis,ST)的嗅觉障碍及其临床特征,分析ST患者与运动症状及非运动症状的关系。方法收取2021年1月到2021年12月就诊于安徽中医药大学神经病学研究所的诊断明确的ST患者共32例,以及与患者组左右利手、性别、年龄、受教育年限大致匹配的健康对照者32例。采用中国科学院心理研究所研发的气味嗅棒对ST组和对照组进行嗅觉阈值、嗅觉分辨、嗅觉识别评估,使用西多伦多痉挛性斜颈评分量表(TWSTRS)、评估ST组的运动症状、残疾指数和疼痛评分,比较两组间的汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、匹兹堡睡眠质量指数(PSQI)、蒙特利尔认知评价量表(MoCA)评分的差异,并分析ST患者嗅觉功能与运动症状和非运动症状之间的相关性。结果(1)ST组的嗅觉阈值、嗅觉分辨、嗅觉识别及嗅觉功能总分均低于对照组(P<0.001),ST组的HAMA(P=0.007)、HAMD(P=0.023)、PSQI(P<0.001)分数均高于对照组,MoCA评分(P>0.05,表1)两组之间无差异性。(2)ST患者的嗅觉识别功能总分与MoCA呈正相关(r=0.589,P=0.000)、与年龄呈负相关(r=-0.385,P=0.03),嗅觉功能与病程、TWSTRS运动评分、TWSTRS残疾评分、TWSTRS疼痛评分、HAMA、HAMD、PSQI无相关性。结论ST患者的嗅觉障碍发生率高,表现为嗅觉阈值、嗅觉分辨、嗅觉识别功能的全面降低,ST的嗅觉障碍与运动症状、疼痛、焦虑、抑郁、睡眠障碍均无相关性。

Objective To investigate the olfactory disorder and clinical characteristics of spastic torticollis(ST),and to analyze the relationship between ST patients and motor symptoms and non motor symptoms.Methods A total of 32 patients with ST diagnosed in the Institute of Neurology of Anhui University of Traditional Chinese medicine from January 2021 to December2021 and 32 healthy controls roughly matched with the right-hand,gender,age and educational background of the patient group were collected the odor thresholds,odor discrimination and odor identification of ST group and control group were evaluated with the olfactory stick developed by the Institute of Psychology of the Chinese Academy of Sciences,Toronto Western spasmodic torticollis rating scale(TWSTRS)was used to evaluate the motor symptoms,disability index and pain score of ST group.The Hamilton Anxiety Rating Scale(HAMA),Hamilton Depression Rating Scale(HAMD),Pittsburgh sleep quality index(PSQI)and Montreal Cognitive Assessment(MoCA)were compared between the two groups.Results(1)The total scores of odor thresholds,odor discrimination,odor identification and olfactory function in ST group were lower than those in the control group(P<0.001),and the scores of HAMA(P=0.007),HAMD(P=0.023)and PSQI(P<0.001)in ST group were higher than those in the control group(P>0.05,table 1)there was no difference between the two groups.(2)The total score of odor identification function in ST patients was positively correlated with MOCA(r=0.589,P=0.000),and negatively correlated with age(r=-0.385,P=0.03).There was no correlation between olfactory function and course of disease,TWSTRS motor score,TWSTRS disability score,TWSTRS pain score,HAMA,HAMD and PSQI.Conclusion The incidence of olfactory disorder in ST patients was high,which was manifested by the overall reduction of odor thresholds,odor discrimination and odor identification function.There was no correlation between olfactory disorder and motor symptoms,pain,anxiety,depression and sleep disorder relevance.