帕金森病中的气味特异性症状——UPSIT-TC气味识别状态与临床严重程度的比较

文献信息

中文摘要

背景： 嗅觉功能障碍是帕金森病（PD）公认的前驱期体征。本研究旨在探讨简短嗅觉测试作为临床实践中评估PD症状更便捷方法的潜力。方法：这项回顾性横断面研究纳入176例PD患者。对于每项临床指标，采用40个独立的logistic回归模型评估其与正确识别每种UPSIT-TC气味之间的关联。在未四舍五入的p < 0.05水平上显示名义关联的气味被指定为候选症状相关气味。当至少两种气味（≥ 2）满足该标准时，构建症状特异性气味评分。随后使用相关性分析和协变量校正回归模型评估每项临床指标与UPSIT-TC总分及其相应症状特异性气味评分的关联。结果：在所有临床指标中，共识别出101个名义气味-临床关联，涉及31种独特气味，其中17项临床指标满足≥ 2种气味标准。症状特异性气味评分与其相应临床指标的未校正相关性通常强于UPSIT-TC总分。在校正年龄、性别、病程和左旋多巴等效日剂量（LEDD），并对32个模型进行错误发现率校正后，症状特异性气味评分仍与MDS-UPDRS总分及第I-III部分评分、运动迟缓、强直、中轴症状、NMSS总分及胃肠道和泌尿域评分、MoCA评分以及NPI总分显著相关。相比之下，UPSIT-TC总分仅与强直保持显著相关。结论：症状特异性气味评分有潜力成为比UPSIT-TC总分更具临床实用性的PD症状负担评估工具。需要进一步开展大规模、多中心研究，以探索对PD临床症状具有更高特异性的气味。

英文摘要

Olfactory dysfunction is a well-recognized prodromal sign of Parkinson's disease (PD). This study aimed to explore the potential of short-form olfactory tests as a more convenient method for assessing PD symptoms in clinical practice. This retrospective cross-sectional study included 176 patients with PD. For each clinical measure, 40 separate logistic regression models evaluated its association with correct identification of each UPSIT-TC odor. Odors showing nominal associations at unrounded p < 0.05 were designated candidate symptom-associated odors. A symptom-specific odor score was constructed when at least two odors (≥ 2) met this criterion. Associations of each clinical measure with the UPSIT-TC total score and its corresponding symptom-specific odor score were subsequently evaluated using correlation analyses and covariate-adjusted regression models. Across all clinical measures, 101 nominal odor-clinical associations involving 31 unique odors were identified, with 17 clinical measures meeting the ≥ 2-odor criterion. Symptom-specific odor scores generally showed stronger unadjusted correlations with their corresponding clinical measures than did the UPSIT-TC total score. After adjustment for age, sex, disease duration, and levodopa equivalent daily dose (LEDD), with false discovery rate correction across 32 models, symptom-specific odor scores remained significantly associated with MDS-UPDRS total and Parts I-III scores, bradykinesia, rigidity, axial symptoms, NMSS total and gastrointestinal and urinary domain scores, MoCA scores, and NPI total scores. In contrast, the UPSIT-TC total score remained significantly associated only with rigidity. Symptom-specific odor scores have the potential to serve as a more clinically practical tool for assessing PD symptom burden than the UPSIT-TC total score. Further large-scale, multicenter studies are needed to explore odors with higher specificity for PD clinical symptoms.