多感官刺激下的嗅觉训练：跨模态整合的神经机制洞察

文献信息

中文摘要

背景： 嗅觉训练（OT）已成为嗅觉功能障碍的一线非药物治疗方法。本研究旨在确定OT期间的多感官刺激是否能改善嗅觉恢复，并探讨其潜在的神经生物学机制。
方法： 招募年龄在18-80岁、患有病毒感染后或特发性嗅觉功能障碍持续至少一个月的个体。参与者被分配接受多感官嗅觉训练（MOT，在OT期间观看与气味一致的视频片段）或常规嗅觉训练（COT），为期三个月。一部分参与者在基线和训练后接受了静息态fMRI检查，以评估嗅觉网络连接的变化，使用梨状皮层和眶额皮层作为预定义的种子区域。统计分析采用重复测量方差分析来评估随时间的变化以及组间差异。
结果： 共纳入95名患者（MOT=51，COT=44）。在所有参与者中观察到气味辨别和复合TDI评分的显著改善，但无显著的时段×组别交互作用。在MOT组中，观察到气味辨别、识别和TDI的训前-训后增益。在MRI亚组中（MOT=21，COT=18），MOT与右侧眶额皮层与枕上回、颞上回及中央后回之间的功能连接降低相关。
结论： MOT与训练期间嗅觉改善相关。尽管组间差异无统计学意义，但探索性神经影像学发现提示MOT后嗅觉与视觉、听觉及躯体感觉区域之间发生了功能重组。将多感官刺激纳入OT作为嗅觉康复的潜在策略值得进一步研究。

英文摘要

BACKGROUND: Olfactory training (OT) has emerged as a first-line non-pharmacological treatment for olfactory dysfunction. This study aimed to determine whether multisensory stimulation during OT improves olfactory recovery and to explore the underlying neurobiological mechanisms.
METHODOLOGY: Individuals aged 18-80 years with post-viral or idiopathic olfactory dysfunction lasting for at least one month were recruited. Participants were allocated to either multisensory OT (MOT, odor-congruent video clips during OT) or conventional OT (COT) for three months. A subset of participants underwent resting-state fMRI at baseline and post-training to evaluate changes in olfactory network connectivity, using the piriform cortex and orbitofrontal cortex as the predefined seed regions. Statistical analyses were performed using repeated-measures ANOVA to evaluate changes over time and between groups.
RESULTS: Ninety-five patients (MOT=51, COT=44) were included. Significant improvements in odor discrimination and composite TDI scores were observed across participants without significant session x group interaction. In the MOT group, pre-post gains were observed in odor discrimination, identification, and TDI. In the MRI subgroup (MOT=21, COT=18), MOT was associated with reduced functional connectivity between the right orbitofrontal cortex and the superior occipital, superior temporal, and postcentral gyri.
CONCLUSIONS: MOT was associated with olfactory improvement over the training period. Although between-group differences were not statistically significant, exploratory neuroimaging findings suggest post-MOT functional reorganization between olfactory and visual, auditory, and somatosensory regions. Incorporating multisensory stimulation into OT warrants further investigation as a potential strategy for olfactory rehabilitation.