2026 年第 3 期 第 21 卷

上呼吸道感染后持续失嗅患者大脑皮层灰质体积变化的纵向研究

A longitudinal study on changes in cerebral cortical gray matter volume in patients with persistent olfactory loss after upper respiratory tract infection

作者：姚淋尹1赵婉2郭怡辰1孙智甫1王建宏1仪晓立3

英文作者：Yao Linyin1 Zhao Wan2 Guo Yichen1 Sun Zhifu1 Wang Jianhong1 Yi Xiaoli3

单位：1首都医科大学附属北京安贞医院耳鼻咽喉头颈外科，北京100029;2中国科学技术大学附属第一医院耳鼻咽喉头颈外科，合肥230001;3首都医科大学附属首都儿童医学中心放射科，北京100020

英文单位：1Department of Otolaryngology Head and Neck Surgery Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Department of Otolaryngology Head and Neck Surgery the First Affiliated Hospital of University of Science and Technology of China Hefei 230001 China; 3Department of Radiology Capital Center for Children′s Health Capital Medical University Beijing 100020 China

关键词：上呼吸道感染后持续失嗅；磁共振成像；基于体素的形态学分析

英文关键词：Persistentolfactorylossafterupperrespiratorytractinfection;Magneticresonanceimaging; Voxel-basedmorphometry

• 摘要：

• 目的 探讨上呼吸道感染后持续失嗅（PURIPOL）患者大脑灰质体积的纵向动态变化。方法 纳入2018年1月至2024年12月于首都医科大学附属北京安贞医院嗅觉味觉障碍诊疗中心就诊的PURIPOL患者20例，男8例、女12例，年龄（41±11）岁，所有患者失嗅持续时间超过2年；另招募年龄、性别和受教育程度匹配的健康志愿者20例作为对照组。通过Sniffin′ Sticks测试（TDI评分）和嗅觉事件相关电位（oERPs）评估主观与客观嗅觉功能，并采用简易精神状态检查量表（MMSE）进行认知功能筛查。回顾性分析PURIPOL患者在失嗅后3～12个月、＞12～24个月、＞24个月三个时期的3D-T1加权脑结构磁共振成像，采用体素的形态测量学（VBM）方法比较其与对照组在灰质体积上的差异，并观察随时间推移的演变规律。结果 PURIPOL组TDI评分明显低于对照组［(5.7±3.1)分比（34.6±2.6）分］（P＜0.01），oERPs表现为N1波和P2波潜伏期较对照组长、振幅较对照组低（均P＜0.01）。VBM分析显示，与对照组相比，PURIPOL组在失嗅3～12个月时右侧眶额皮层与左侧直回灰质体积显著减少；失嗅＞12～24个月时，右侧眶额皮层及双侧直回灰质体积进一步减少；失嗅>24个月时，灰质萎缩范围扩展至双侧眶额皮层、双侧直回及右侧岛叶（FDR校正，均P＜0.001）。结论 PURIPOL患者嗅觉相关脑区存在进行性灰质体积减少，提示长期嗅觉输入缺如可能导致相应脑区出现结构重塑，这可能是持续失嗅的重要中枢机制之一。

• Objective To investigate the longitudinal dynamic changes in cerebral gray matter volume in patients with persistent olfactory loss after upper respiratory tract infection (PURIPOL). Methods A total of 20 PURIPOL patients (8 males and 12 females, aged 41±11 years) with olfactory loss lasting more than 2 years who were treated at the olfactory and gustatory disorders diagnosis and treatment center of Beijing Anzhen Hospital, Capital Medical University from January 2018 to December 2024 were enrolled. Another 20 age-, gender- and education-matched healthy volunteers were recruited as the control group. Subjective and objective olfactory functions were evaluated by the Sniffin′ sticks test (TDI score) and olfactory event-related potentials (oERPs), and cognitive function was screened by the mini-mental state examination (MMSE). Retrospective analysis was performed on the 3D-T1-weighted brain structural magnetic resonance imaging of PURIPOL patients at three stages: 3-12 months, >12-24 months and >24 months after the onset of olfactory loss. Voxel-based morphometry (VBM) was used to compare the differences in gray matter volume between PURIPOL patients and the control group, and to observe the evolutionary law over time. Results The TDI score of the PURIPOL group was significantly lower than that of the control group ［(5.7±3.1) vs (34.6±2.6)］(P＜0.01). The oERPs of the PURIPOL group showed longer latencies and lower amplitudes of N1 and P2 waves than those of the control group (all P＜0.01). VBM analysis revealed that compared with the control group, the PURIPOL group had a significant reduction in gray matter volume in the right orbitofrontal cortex and left gyrus rectus at 3-12 months after olfactory loss; the gray matter volume in the right orbitofrontal cortex and bilateral gyrus rectus further decreased at >12-24 months; and the scope of gray matter atrophy extended to the bilateral orbitofrontal cortex, bilateral gyrus rectus and right insula at >24 months (FDR corrected, all P＜0.001). Conclusion Progressive reduction in gray matter volume exists in olfactory-related brain regions of PURIPOL patients, suggesting that long-term lack of olfactory input may lead to structural remodeling in the corresponding brain regions, which may be one of the important central mechanisms of persistent olfactory loss.