系统性红斑狼疮和系统性硬化症的嗅觉功能。一项纵向研究和文献回顾。
Olfactory function in systemic lupus erythematosus and systemic sclerosis. A longitudinal study and review of the literature.
机构信息
Physiopathology Graduate Program, School of Medical Sciences, University of Campinas, Brazil; Rheumatology Lab, School of Medical Sciences, University of Campinas, Brazil; Autoimmunity Lab School of Medical Sciences, University of Campinas, Brazil.
Medicine Graduate Program, School of Medical Sciences, University of Campinas, Brazil; Rheumatology Lab, School of Medical Sciences, University of Campinas, Brazil; Autoimmunity Lab School of Medical Sciences, University of Campinas, Brazil.
出版信息
Autoimmun Rev. 2018 Apr;17(4):405-412. doi: 10.1016/j.autrev.2018.02.002. Epub 2018 Feb 11.
BACKGROUND/PURPOSE: To evaluate olfactory function in systemic lupus erythematosus (SLE), systemic sclerosis (SSc) and healthy controls over a 2-year period, and to determine the association of olfactory dysfunction with age, disease activity, disease damage, treatment, anxiety and depression symptoms and limbic structures volumes.
METHODS
Consecutive SLE and SSc patients were enrolled in this study. Clinical, laboratory disease activity and damage were assessed according to diseases specific guidelines. Olfactory functions were evaluated using the Sniffin' Sticks test (TDI). Volumetric magnetic resonance imaging (MRI) was obtained in a 3T Phillips scanner. Amygdalae and hippocampi volumes were analyzed using FreeSurfer® software.
RESULTS
We included 143 SLE, 57 SSc and 166 healthy volunteers. Olfactory dysfunction was observed in 78 (54.5%) SLE, 35 (59.3%) SSc patients and in 24 (14.45%) controls (p<0.001) at study entry. SLE and SSc patients had significantly lower mean in all three phases (TDI) of the olfactory assessment when compared with healthy volunteers. In SLE, the presence of olfactory dysfunction was associated with older age, disease activity, higher anxiety and depression symptoms score, smaller left hippocampus volume, smaller left and right amygdalae volume and the presence of anti-ribosomal P (anti-P) antibodies. In SSc the presence of olfactory impairment was associated with older age, disease activity, smaller left and right hippocampi volumes and smaller right amygdala volume. Olfactory function was repeated after a 2-year period in 90 SLE, 35 SSc and 62 controls and was stable in all three groups.
CONCLUSION
Both SLE and SSc patients with longstanding disease had significant reduction in all stages of TDI that maintained stable over a 2-year period. Olfactory dysfunction was associated with age, inflammation and hippocampi and amygdalae volumes. In SLE, additional association with anti-P, anxiety and depression symptoms was observed.
背景/目的：评估系统性红斑狼疮（SLE）、系统性硬皮病（SSc）和健康对照组患者的嗅觉功能在 2 年内的变化，并确定嗅觉功能障碍与年龄、疾病活动度、疾病损害、治疗、焦虑和抑郁症状以及边缘结构体积的关系。
方法
本研究纳入了连续的 SLE 和 SSc 患者。根据疾病特异性指南评估临床、实验室疾病活动度和损害。使用 Sniffin' Sticks 测试（TDI）评估嗅觉功能。在 3T Phillips 扫描仪上进行磁共振成像（MRI）容积扫描。使用 FreeSurfer®软件分析杏仁核和海马体体积。
结果
我们纳入了 143 例 SLE、57 例 SSc 和 166 名健康志愿者。在研究开始时，78 例（54.5%）SLE、35 例（59.3%）SSc 患者和 24 例（14.45%）健康对照组存在嗅觉功能障碍（p<0.001）。与健康志愿者相比，SLE 和 SSc 患者在嗅觉评估的所有三个阶段（TDI）的平均得分均显著较低。在 SLE 中，嗅觉功能障碍的存在与年龄较大、疾病活动度较高、焦虑和抑郁症状评分较高、左侧海马体体积较小、左侧和右侧杏仁核体积较小以及存在抗核糖体 P（抗-P）抗体有关。在 SSc 中，嗅觉障碍的存在与年龄较大、疾病活动度较高、左侧和右侧海马体体积较小以及右侧杏仁核体积较小有关。在 90 例 SLE、35 例 SSc 和 62 例健康对照组中重复了嗅觉功能检查，并且在所有三组中都保持稳定。
结论
患有长期疾病的 SLE 和 SSc 患者的 TDI 所有阶段均显著降低，并且在 2 年内保持稳定。嗅觉功能障碍与年龄、炎症以及海马体和杏仁核体积有关。在 SLE 中，还观察到与抗-P、焦虑和抑郁症状的额外关联。
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