摘要目的 分析帕金森病(PD)患者主观嗅觉功能、嗅球体积、嗅沟深度的变化及其对PD的诊断价值. 方法 选择上海市浦东新区浦南医院神经内科自2014年1月至2015年10月收治的PD患者34例(PD组)和其他神经系统疾病患者20例(疾病对照组),另外选择本院同期体检中心的健康体检者25例(健康对照组),应用五味嗅觉测试液检测受试者的嗅觉察觉阈值(DT)和嗅觉识别阈值(IT),应用磁共振成像(MRI)检测受试者的嗅球体积和嗅沟深度.比较3组受试者及不同病程、Hoehn-Yahr(H-Y)分级PD患者的嗅觉功能、嗅球体积和嗅沟深度;分析嗅球体积与嗅觉功能的相关性及其联合检测在PD诊断中的敏感度和特异度. 结果 与疾病对照组、健康对照组相比,PD组患者的DT和IT明显升高,嗅球体积明显缩小,差异有统计学意义(P＜0.05);病程≥4年PD患者的嗅球体积小于病程＜4年PD患者,H-Y分级Ⅱ级、Ⅲ级PD患者的嗅球体积小于Ⅰ级患者,差异均有统计学意义(P＜0.05);PD组患者的DT、IT与嗅球体积均呈负相关关系(r=-0.607,P=0.000;r=-0.898,P=0.000);嗅球体积单独诊断PD的敏感度为64.7％;联合IT与嗅球体积2个指标诊断时可使敏感度提高至67.7％,特异度提高至100％. 结论 PD患者嗅觉功能减退,嗅球体积减小,且二者呈正相关;嗅觉功能及嗅球体积联合检测对PD的诊断具有重要意义.

abstractsObjective To analyze the changes of olfactory function,olfactory bulb volume,depth of olfactory sulcus in patients with Parkinson's disease (PD) and their diagnostic values in PD.Methods Thirty-four PD patients,20 patients with other neurological diseases and 25 healthy controls,collected in our hospital from January 2014 to October 2015,were enrolled.The olfactory detection threshold (DT) and identification threshold (IT) of these three groups were determined by using "five odors olfactory detection arrays".Olfactory bulb volume and depth of olfactory sulcus were assessed with MR imaging.The olfactory function,olfactory bulb volume,depth of olfactory sulcus in the three groups,and PD patients of different disease courses and H-Y grading were compared.The relation of olfactory function with olfactory bulb volume was analyzed,and the sensibility and specificity of their combination in PD detection.Results Olfactory testing revealed that PD patients (DT=0.59±0.46,IT=2.01±0.48) had higher scores of DT and IT than group of other neurological diseases (DT=-0.33±0.40,IT=1.13± 0.45) and healthycontrols (DT=-0.22±0.41,IT=1.06±0.38),with significantdifferences (P＜0.05).Average olfactory bulb volume in PD group (31.71±3.23 mm3) was smaller than that in group of other neurological diseases (39.52±4.47 mm3) and healthy controls (41.60±4.24 mm3),with significant differences (P＜0.05).The olfactory bulb volume in PD patients of disease courses ≥4 years was significantly smaller than that in PD patients of disease courses ＜4 years (P＜0.05).The olfactory bulb volume in PD patients of H-Y grading Ⅱ and Ⅲ was significantly smaller than that in PD patients of H-Y grading I (P＜0.05).Olfactory threshold was negatively correlated with average olfactory bulb volume in PD patients (DT:r=-0.607,P=0.000;IT:r=-0.898,P=0.000).The sensitivity in PD diagnosis was 64.7％ by olfactory bulb volume only;the sensitivity and specificity in PD diagnosis increased to 67.7％ and 100.0％,respectively,by combining the olfactory IT and olfactory bulb volume.Conclusion Olfactory dysfunction and decreased olfactory bulb volume are noted in PD patients;the olfactory bulb volume is positively correlated with olfactory function;olfactory function combined MR imaging examination might play an important role in the diagnosis of PD.