COVID-19 嗅觉功能障碍的神经放射学基础：系统评价和荟萃分析。
Neuroradiological Basis of COVID-19 Olfactory Dysfunction: A Systematic Review and Meta-Analysis.
机构信息
Department of Undergraduate Medicine, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore.
Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital (SGH), Singapore, Singapore.
出版信息
Laryngoscope. 2022 Jun;132(6):1260-1274. doi: 10.1002/lary.30078. Epub 2022 Mar 22.
OBJECTIVE
Olfactory dysfunction (OD) is a common presenting symptom of COVID-19 infection. Radiological imaging of the olfactory structures in patients with COVID-19 and OD can potentially shed light on its pathogenesis, and guide clinicians in prognostication and intervention.
METHODS
PubMed, Embase, Cochrane, SCOPUS were searched from inception to August 1, 2021. Three reviewers selected observational studies, case series, and case reports reporting radiological changes in the olfactory structures, detected on magnetic resonance imaging, computed tomography, or other imaging modalities, in patients aged ≥18 years with COVID-19 infection and OD, following preferred reporting items for systematic reviews and meta-analyses guidelines and a PROSPERO-registered protocol (CRD42021275211). We described the proportion of radiological outcomes, and used random-effects meta-analyses to pool the prevalence of olfactory cleft opacification, olfactory bulb signal abnormalities, and olfactory mucosa abnormalities in patients with and without COVID-19-associated OD.
RESULTS
We included 7 case-control studies (N = 353), 11 case series (N = 154), and 12 case reports (N = 12). The pooled prevalence of olfactory cleft opacification in patients with COVID-19 infection and OD (63%, 95% CI = 0.38-0.82) was significantly higher than that in controls (4%, 95% CI = 0.01-0.13). Conversely, similar proportions of cases and controls demonstrated olfactory bulb signal abnormalities (88% and 94%) and olfactory mucosa abnormalities (2% and 0%). Descriptive analysis found that 55.6% and 43.5% of patients with COVID-19 infection and OD had morphological abnormalities of the olfactory bulb and olfactory nerve, respectively, while 60.0% had abnormal olfactory bulb volumes.
CONCLUSION
Our findings implicate a conductive mechanism of OD, localized to the olfactory cleft, in approximately half of the affected COVID-19 patients. Laryngoscope, 132:1260-1274, 2022.
目的
嗅觉功能障碍（OD）是 COVID-19 感染的常见表现症状。对 COVID-19 患者和 OD 患者的嗅觉结构进行影像学检查，可能有助于了解其发病机制，并为临床医生的预后和干预提供指导。
方法
检索了从建库至 2021 年 8 月 1 日的 PubMed、Embase、Cochrane、SCOPUS 数据库。由 3 位评审员筛选出观察性研究、病例系列研究和病例报告，这些研究均报告了≥18 岁 COVID-19 感染和 OD 患者的嗅觉结构的影像学改变，使用磁共振成像、计算机断层扫描或其他影像学方式检测，符合系统评价和荟萃分析报告规范以及 PROSPERO 注册的方案（CRD42021275211）。我们描述了影像学结果的比例，并使用随机效应荟萃分析来汇总 COVID-19 相关性 OD 患者和无 OD 患者的嗅裂混浊、嗅球信号异常和嗅黏膜异常的患病率。
结果
我们纳入了 7 项病例对照研究（N=353）、11 项病例系列研究（N=154）和 12 项病例报告（N=12）。COVID-19 感染和 OD 患者嗅裂混浊的患病率为 63%（95%CI=0.38-0.82），显著高于对照组（4%，95%CI=0.01-0.13）。相比之下，病例和对照组嗅球信号异常（88%和 94%）和嗅黏膜异常（2%和 0%）的比例相似。描述性分析发现，55.6%和 43.5%的 COVID-19 感染和 OD 患者的嗅球和嗅神经分别存在形态学异常，60.0%的患者嗅球体积异常。
结论
我们的研究结果提示 COVID-19 患者中约一半的 OD 为嗅觉传导机制障碍，局限于嗅裂。喉镜，132：1260-1274，2022。
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