Schmidt Felix A, Maas Matthew B, Geran Rohat, Schmidt Charlotte, Kunte Hagen, Ruprecht Klemens, Paul Friedemann, Göktas Önder, Harms Lutz
Clinical and Experimental Multiple Sclerosis Research Center (F.A.S., R.G., H.K., K.R., F.P., L.H.), Department of Neurology, NeuroCure Clinical Research Center (F.A.S., F.P.), Department of Psychiatry (C.S.), Department of Audiology and Phoniatrics (Ö.G.), Charité-Universitätsmedizin Berlin (F.P.), Germany; Department of Neurology (M.B.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL; MSB Medical School Berlin (H.K.), Germany; and Experimental and Clinical Research Center (F.P.), Max Delbrück Center for Molecular Medicine, Berlin, Germany.
Neurol Neuroimmunol Neuroinflamm. 2017 Jun 14;4(4):e369. doi: 10.1212/NXI.0000000000000369. eCollection 2017 Jul.
We tested the hypothesis that olfactory function is more impaired in patients with primary progressive MS (PPMS) than that in relapsing-remitting MS (RRMS).
Standardized olfactory testing was performed in 32 patients with PPMS, 32 patients with RRMS, and 32 healthy controls (HCs). Patients with olfactory dysfunction due to an alternative primary etiology were excluded. The validated olfactory testing method yielded individual scores for olfactory threshold, odor discrimination, and odor identification, along with a composite Threshold Discrimination Identification (TDI) score.
Olfactory dysfunction was identified in 27 (84%) patients with PPMS, 10 (31%) patients with RRMS, and 1 (3%) HC. While age and sex were similar between PPMS and HCs, the TDI score and all olfactory subscores were significantly worse in patients with PPMS compared with HCs (all < 0.001). After adjustment for differences in age, sex, Expanded Disability Status Scale (EDSS), and disease duration, odor discrimination, odor identification, and the composite TDI score were worse in patients with PPMS vs RRMS ( = 0.03, 0.04, and 0.02, respectively). Neither age, sex, EDSS, nor disease duration was significantly associated with the composite TDI score.
Olfactory dysfunction was more frequent and severe in PPMS compared with RRMS, independent of disease duration and overall disability status. Further research on cellular level differences in olfactory neural pathways may lead to new insights about disease pathogenesis in MS.
我们检验了以下假设，即原发性进展型多发性硬化症（PPMS）患者的嗅觉功能比复发缓解型多发性硬化症（RRMS）患者受损更严重。
对32例PPMS患者、32例RRMS患者和32名健康对照者（HCs）进行了标准化嗅觉测试。排除因其他原发性病因导致嗅觉功能障碍的患者。经过验证的嗅觉测试方法得出了嗅觉阈值、气味辨别和气味识别的个体分数，以及一个综合的阈值辨别识别（TDI）分数。
在27例（84%）PPMS患者、10例（31%）RRMS患者和1名（3%）HC中发现嗅觉功能障碍。虽然PPMS患者和HCs在年龄和性别上相似，但与HCs相比，PPMS患者的TDI分数和所有嗅觉子分数明显更差（均<0.001）。在调整年龄、性别、扩展残疾状态量表（EDSS）和病程的差异后，PPMS患者的气味辨别、气味识别和综合TDI分数比RRMS患者更差（分别为=0.03、0.04和0.02）。年龄、性别、EDSS和病程均与综合TDI分数无显著相关性。
与RRMS相比，PPMS患者的嗅觉功能障碍更频繁、更严重，与病程和整体残疾状态无关。对嗅觉神经通路细胞水平差异的进一步研究可能会为MS疾病发病机制带来新的见解。
