摘要目的:利用基于体素形态学测量（voxel-based morphometry，VBM）和表面形态学测量（surface-based morphometry，SBM）方法，探讨上呼吸道感染后嗅觉障碍（post infectious olfactory dysfunction，PIOD）患者脑灰质形态学变化及影响因素，为探索PIOD的神经病理机制提供科学依据。方法:选取2020年1月至2024年12月间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46例PIOD患者（PIOD组）和46例嗅觉功能正常的志愿者（对照组），两组均行嗅觉心理物理测试（Sniffin′ Sticks）和嗅觉事件相关电位（olfactory event-related potential，oERP）检查。采集两组受试者全脑薄层T1加权三维MRI结构像数据，以VBM方法分析两组间灰质体积差异有统计学意义的脑区，以SBM方法分析两组间皮层厚度、折叠系数的差异，并分析有差异脑区灰质体积与病程、Sniffin′ Sticks结果及oERP参数的相关性。以双侧 P<0.05为差异有统计学意义。 结果:两组受试者间的年龄、性别、受教育时间和简易智能精神状态检查量表评分差异均无统计学意义（ t=1.80、 χ2=0.41、 t=0.17、 t=1.77， P值均 >0.05）。与对照组相比，PIOD组Sniffin′ Sticks检测值降低（ t=28.70， P<0.001），oERP的各波潜伏期延长，振幅减低（ P值均<0.001）；VBM结果显示PIOD组右侧眶额皮层（orbitofrontal cortex，OFC）灰质体积显著减小（ t=5.38， P<0.001），SBM结果显示右侧OFC厚度显著减小（ t=5.27， P<0.001），未发现折叠系数有差异的脑区。右侧OFC灰质体积与病程呈负相关（ r=-0.61， P<0.001），与Sniffin′ Sticks结果及oERP参数间均无统计学意义相关性。 结论:PIOD患者右侧OFC萎缩且与病程相关，这表明嗅觉功能障碍持续存在可能与神经退行性改变相关。

abstractsObjective:To explore the alterations in gray matter morphology and contributing factors in patients with post-infectious olfactory dysfunction (PIOD) using voxel-based morphometry (VBM) and surface-based morphometry (SBM), thereby providing scientific insights into the neuropathological mechanisms underlying PIOD.Methods:A total of 46 PIOD patients (PIOD group) and 46 normosmic volunteers (control group) were recruited from the Smell and Taste Disorders Clinic of Beijing Anzhen Hospital, Capital Medical University, between January 2020 and December 2024. All participants underwent olfactory psychophysical tests (Sniffin′ Sticks) and olfactory event-related potential (oERP) examination. High-resolution T1-weighted 3D MRI structural images were obtained for both groups. VBM was employed to analyze inter-group differences in gray matter volume, while SBM was used to assess cortical thickness and folding index. Correlations between gray matter volume in significant difference brain regions and disease duration, Sniffin′ Sticks scores, oERP parameters were analyzed. A two-tailed P<0.05 was considered statistically significant. Results:No significant differences were observed in age, sex, education level, or Mini-Mental State Examination (MMSE) scores ( t=1.80, χ2=0.41, t=0.17, t=1.77, all P>0.05). Compared with controls, the PIOD group showed significantly lower Sniffin′ Sticks scores ( t=28.70, P<0.001), prolonged oERP latencies and reduced amplitudes (all P<0.001). VBM revealed significantly reduced gray matter volume in the right orbitofrontal cortex (OFC) in the PIOD group ( t=5.38, P<0.001). SBM demonstrated decreased cortical thickness in the right OFC ( t=5.27, P<0.001), with no significant differences in folding index. The gray matter volume in the right OFC was negatively correlated with disease duration ( r=-0.61, P<0.001), but no significant correlations were found with Sniffin′ Sticks scores or oERP parameters. Conclusion:Patients with PIOD show atrophy in the right OFC, which correlates with disease duration, suggesting that persistent olfactory dysfunction may be associated with neurodegenerative changes.