帕金森病与血管性帕金森综合征嗅觉功能改变的研究

目的：研究帕金森病(PD)与血管性帕金森综合征(VP)的嗅觉功能改变及其影响因素，探讨Sniffin' Sticks方法(SST)嗅觉功能检查在PD诊断和鉴别诊断中的应用价值。方法选取2015年3~12月在南通大学第二附属医院就诊的PD、VP患者及性别、年龄匹配的同期体检正常对照者（HC组）各40例。采用SST检查方法分别评价PD、VP、HC三组受检者的嗅觉阈值(OT)、嗅觉辨别阈值(OD)、嗅觉识别阈值(OI)及三项得分之和(TDI)总分，比较三组受检者间嗅觉功能的差异，并评估其嗅觉功能与年龄、性别、简易精神状态量表（MMSE）、病程、H-Y分级、统一帕金森病评定量表(UPDRS-Ⅲ)等变量的相关性。应用受试者工作特征曲线(ROC)评价TDI在PD诊断中的价值。结果 PD、VP、HC三组受检者间基线资料比较差异均无统计学意义(P>0.05)；PD组嗅觉障碍发生率为92.5%，显著高于VP组(37.5%)及HC组(35.0%)，差异有统计学意义(P<0.05)；PD、VP、HC三组受检者的TDI总分分别为(20.07±4.45)分、(30.53±5.90)分和(31.00±4.99)分，PD组TDI总分明显低于HC组和VP组(P<0.05)，而VP组与HC组间比较差异无统计学意义(P>0.05)；HC组TDI总分与年龄呈负相关(r=-0.987，P<0.05)，与MMSE呈正相关(r=0.866，P<0.05)；PD组TDI总分与病程呈负相关(r=-0.484，P<0.05)，与MMSE呈正相关(r=0.618，P<0.05)，与性别、年龄、H-Y分级及UPDRS-Ⅲ评分无关；VP组TDI总分与年龄、病程、H-Y分级均呈负相关(分别为r=-0.989，P<0.05；r=-0.770，P<0.05；r=-0.353，P<0.05)，与MMSE呈正相关(r=0.838，P<0.05)，与性别、UPDRS-Ⅲ评分无关；区分PD组和HC组时TDI总分曲线下面积(AUC)为0.944，临界值为23.313，灵敏度为82.5%，特异度为97.5%；区分PD组和VP组时，TDI总分AUC为0.911，临界值为23.563，灵敏度为87.5%，特异度为82.5%。结论 SST嗅觉检测方法临床应用简单、结果可靠、可操作性强；PD存在较为显著的嗅觉障碍，VP嗅觉功能与HC比较无显著差异；使用SST能够为PD的诊断和鉴别诊断提供重要的参考信息。

Changes of olfactory function in patients with Parkinson's disease and vascular parkinsonism

Objective To study the changes of olfactory function in patients with Parkinson's disease (PD) and vascular parkinsonism (VP) and their influence factors, and to explore the application value of olfactory function exami-nation by Sniffin'Sticks test (SST) in diagnosis and differential diagnosis of PD. Methods Forty participants with PD (PD group), 40 participants with VP (VP group) and 40 healthy controls (HC group) were included in the study. All of the participants were treated in the Second Affiliated Hospital of Nantong University from March 2015 to December 2015 with gender and age matched. Sniffin'Sticks test (SST) was used to assess olfactory function of all participants in three groups, including odor threshold (OT), odor discrimination (OD), odor identification (OI) and TDI total score. TDI score comparison was performed among PD, VP and HC groups. The relationships between olfactory function and age, gender, Minimum Mental State Examination (MMSE), disease duration, H-Y rating and UPDRS-Ⅲ score were ana-lyzed. Receiver operator characteristic curve (ROC) was used to evaluate the application value of TDI score in diagnosis of PD. Results The baseline characteristic information among PD, VP and HC group showed no statistically significant difference (P>0.05). The prevalence of olfactory dysfunction in PD group was 92.5%, which was significantly higher than that in VP group (37.5%) and HC group (35.0%), P<0.05. The TDI score was (20.07 ± 4.45) in PD group, (30.53 ± 5.90) in VP group and (31.00±4.99) in HC group. Compared to VP and HC group, TDI score was significantly decreased in PD group, while no statistically significant difference was found between VP and HC groups. In HC group, TDI score was negatively correlated with age (r=-0.987, P<0.05) and positively correlated with MMSE score (r=0.866, P<0.05). In PD group, TDI score was negatively correlated with disease duration (r=-0.484, P<0.05) and positively correlated with MMSE score (r=0.618, P<0.05), but had nothing to do with age, gender, H-Y rating and UPDRS-Ⅲscore. In VP group, TDI score was negatively correlated with age, disease duration and H-Y rating (r=-0.989, P<0.05; r=-0.770, P<0.05;r=-0.353, P<0.05 respectively) and positively correlated whth MMSE (r=0.838, P<0.05), while not correlated with gender and UPDRS-Ⅲ score. The area under ROC curve (AUC) of TDI for discriminating PD group and HC group was 0.944, with cut-off value of 23.313, sensitivity of 82.5% and specificity of 97.5%. The AUC of TDI score for discriminating PD group and VP group was 0.911, with cut-off value of 23.563, sensitivity of 87.5%and specificity of 82.5%. Conclusion SST is a simple, reliable tool for evaluating olfactory function. Obvious olfacto-ry dysfunction was observed in PD patients, and no significant difference was found in olfactory function between VP and HC groups. The use of SST may provide important clinical information with its high sensitivity and specificity in the diagnosis and differential diagnosis of PD.