不同治疗方法对COVID相关嗅觉功能障碍患者的影响：一项系统评价和网络荟萃分析

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中文摘要

背景： 嗅觉功能障碍（OD）是2019冠状病毒病（COVID-19）常见的神经系统后遗症，并显著损害生活质量。尽管已提出多种药物和非药物干预措施，但其相对疗效仍存在争议。本研究旨在比较现有干预措施对COVID-19后OD的疗效。
方法： 系统检索了PubMed、Embase、Cochrane Library和Web of Science数据库，检索截止日期为2025年7月31日。纳入评估COVID-19后OD干预措施的随机对照试验（RCT）、队列研究和非RCT研究。使用美国国立卫生研究院（NIH）量表和纽卡斯尔-渥太华量表（NOS）评估研究质量。使用RStudio和Stata分析数据。通过累积排名曲线下面积（SUCRA）值对干预措施进行排序。
结果： 共纳入44项研究，涉及3,516例患者和26种干预措施，总体质量为中等至高等。螯合剂（标准化均数差[SMD = 3.61]，95%可信区间[CrI]：2.77，4.55）显著改善总嗅觉评分及其子域（SUCRA值为98.2%）。富血小板血浆（SMD = 1.33，95% CrI：0.92，1.74）显著改善宾夕法尼亚大学嗅觉识别测试（UPSIT）结果。皮质类固醇通过视觉模拟量表（VAS）显示显著改善嗅觉功能（SMD = 1.99，95% CrI：0.52，3.48）。功能性鼻中隔成形术（FSPR）在鼻窦相关生活质量方面表现出更优改善，通过22项鼻窦结局测试（SNOT-22）测量（SMD = -1.06，95% CrI：-1.91，-0.21）。
结论： 螯合剂及螯合剂联合其他干预措施在改善COVID-19后嗅觉功能方面显示出益处，为多靶点治疗提供了新方向。需要进一步的高质量RCT来证实这些发现。

英文摘要

BACKGROUND: Olfactory Dysfunction (OD) is a prevalent neurological sequela of Coronavirus Disease 2019 (COVID-19) and substantially impairs quality of life. Although multiple pharmaceutical and non-pharmaceutical interventions have been proposed, their relative efficacy remains controversial. This study aimed to compare the efficacy of existing interventions for post-COVID-19 OD.
METHODS: PubMed, Embase, the Cochrane Library, and Web of Science databases were systematically searched up to July 31, 2025. Randomized Controlled Trials (RCTs), cohort studies, and non-RCT studies evaluating interventions for post-COVID-19 OD were included. Study quality was assessed using the National Institutes of Health (NIH) scale and the Newcastle-Ottawa Scale (NOS). Data were analyzed using RStudio and Stata. The interventions were ranked by Surface Under the Cumulative Ranking (SUCRA) values.
RESULTS: A total of 44 studies involving 3,516 patients and 26 interventions were included, with overall moderate to high quality. Chelators (Standardized Mean Difference [SMD = 3.61], 95% Credible Interval [CrI]: 2.77, 4.55) significantly improved total olfactory scores and their subdomains (with SUCRA values of 98.2%). Platelet-rich plasma (SMD = 1.33, 95% CrI: 0.92, 1.74) markedly improved the results of the University of Pennsylvania Smell Identification Test (UPSIT). Corticosteroids substantially improved olfactory function, as revealed by the Visual Analogue Scale (VAS) (SMD = 1.99, 95% CrI: 0.52, 3.48). Functional Septorhinoplasty (FSPR) demonstrated superior improvement in sinonasal-related quality of life, as measured by the 22-item Sino-nasal Outcome Test (SNOT-22) (SMD = -1.06, 95% CrI: -1.91, -0.21).
CONCLUSION: Chelators and chelators combined with other interventions demonstrated benefit in improving post-COVID-19 olfactory function, offering new directions for multi-target therapies. Further high-quality RCTs are required to confirm these findings.