生物与医学2022jamanetwork.com
新冠患者嗅组织退化的尸检评估
Postmortem assessment of olfactory tissue degeneration in patients with Covid-19
专业 · 约 35 分钟读完前置知识：病理学基础、嗅觉系统解剖、COVID-19 临床知识
导读
这是一项尸检队列研究，用新冠死者的嗅球和嗅黏膜组织做病理检查，发现感染可导致嗅组织内轴突损伤和微血管病变；自觉嗅觉改变的患者，其嗅觉病理改变比嗅觉正常者更严重。研究提示嗅觉丧失可能与嗅黏膜局部的神经和血管损伤有关，而不是笼统的“脑损伤”。
HN 关注点：论文标题被改写夸大的问题：原文标题其实很克制，但提交到 HN 的标题变成了“嗅觉丧失与脑损伤相关”，有夸大之嫌；评论里还分享了各种嗅觉、味觉异常的个人经历和替代解释。
HN 评论精选
这几条评论里：质疑 1 补充 1 亲历 2
补充指出 HN 标题夸大，论文实际结论只是嗅组织局部的神经血管损伤。
从结论看：“这项尸检队列研究的结果表明，新冠感染可导致嗅组织中的轴突损伤和微血管病变。总体而言，嗅觉改变患者的嗅觉病理改变比嗅觉正常者更严重。”通俗地说，就是报告嗅觉丧失的人鼻内神经和血管受到了损伤。这个结论以及论文原标题远比提交到 HN 的标题（“新冠嗅觉丧失与脑损伤相关”）平淡，也没那么危言耸听。
hammock查看英文原文
From the conclusion: >The results of this postmortem cohort study demonstrated that COVID-19 infection could cause axon injuries and microvasculopathy in olfactory tissue. Overall, patients with smell alterations had more severe olfactory pathology than those with intact smell. In layman's terms, people who reported loss of smell had damage to the nerves and blood vessels in their nose. That conclusion, and the paper's actual title, is quite a bit more mundane and less alarmist than the submitted title here ("Covid Smell Loss Linked to Damage in Brain").
亲历亲历：新冠后出现短暂味觉扭曲，补锌后一天内恢复。
我的情况挺奇怪。感染新冠后，我对酒精的味道被“搞坏”了：喝一口葡萄酒或啤酒，最初 200 毫秒味道正常，随后一股极苦的余味涌上来，盖过其他所有味道。持续了几周，然后某一天之内就自己好了。那段时间我正好在吃锌片，因为有人说味觉异常有时是缺锌引起的。
aenis查看英文原文
I had a weird one. Got covid and my taste for alcohol got ...corrupted. For the first 200ms of a sip of wine or beer it tasted normally, and then a wave of extremely bitter aftertaste would come and drown all the other tastes. It lasted a few weeks and then it fixed itself in the course of one day. It did coincide with me taking a few zinc pills as someone told me taste anomalies are sometimes caused by zinc deficiencies.
亲历亲历：长期嗅觉倒错和味觉改变对生活质量影响极大，甚于急性症状。
疫苗问世前我感染过两次新冠。第一次是我这辈子病得最重的一次，几乎没力气走到洗手间。第二次我部分失去了嗅觉……说实话，我宁愿再经历十次第一种，也不愿经历那一次。现在我要面对的是：某些东西完全尝不出、闻不到；还会出现幻嗅，比如今天办公室闻起来全是柴油味；还有些味道因为其他味道被削弱而显得格外强烈。脑雾和嗜睡终于好了，但我知道精力大概永远回不到从前，除非我拼命锻炼。橙子？以前很喜欢，现在受不了，完全尝不出那种酸甜的柑橘味。辣椒？以前很喜欢，现在只能接受炖得很烂、不是主料的。碎牛肉？做成肉饼或肉糕还行，但肉馅不行，不知为什么，它进去和出来的气味一模一样，像罐装狗粮。太糟了。我年轻时抽很多雪茄，晚上在 Google Hangouts 上给人科普这个行业、品牌和收藏。后来减到每月一两次，晚上抽着放松……
MisterBastahrd查看英文原文
Caught COVID twice before the vaccines were available. First bout was the first time in my life that I was so physically ill that I barely had the strength to make it to the restroom. Second time is when I partially lost my sense of smell... and honestly, I'd rather go through 10 of the first type than have ever gone through the second. Now, I get to deal with the fun of not being able to taste / smell certain things AT ALL, phantom smells like today when it seems like my office is full of diesel fumes, and heightened tastes of other things due to the muting of some of those tastes. I've finally recovered from the brain fog and the narcolepsy, but I also know that my energy levels will probably never be where they used to be unless I train far harder than I'm willing to given my lifestyle. Oranges? Loved them. Can't stand them. I have zero ability to taste the sweet and sour citrus component. Peppers? Loved them. Can now only tolerate them if they are VERY cooked down and not a main component of a dish. Ground beef? I can tolerate in patty or loaf form. Not ground for some reason. It smells exactly the same going in one end and out the other... like canned dog food. It's terrible. I used to smoke a lot of cigars years ago, and spend my evenings on google hangouts educating people about the industry and the brands and the hobby of collecting them. I brought that level waaaaaaaaay down to maybe one or two a month, smoking them in the evenings to unwind and relax. They no longer bring me joy because I spend my time trying to figure out what I can still taste out of brands that should be relatively consistent. So now it feels like I have this watch spring inside me that is just wound up with no way to release it, and the thing that used to give me peace now just irks my nerves. I've described this to people and they'll say "oh, just do some yoga or meditation or something"... when the entire point of the original exercise was to just sit there, focus on something I enjoyed, and let the world pass by. Ugh. Oh, and the best part? Twice, my kids brought it home from school. "But kids don't die from it, so why vaccinate them?" Because that's why. They're little disease vectors for every other thing on the planet, so what makes anyone think they're immune from this?
质疑补充反例：星状神经节阻滞能缓解症状，质疑“器质性损伤”是唯一机制。
奇怪的是，很多尝试过星状神经节阻滞的人表示，嗅觉和味觉问题完全缓解了。所以这个“损伤”也许并不是病因。链接：pubmed.ncbi.nlm.nih.gov/34922127/
jokowueu查看英文原文
What's odd that many people who tried stellate gangelion block found complete relief from smell and taste issues . So this whole "damage" issue might not be the reason for this cause https://pubmed.ncbi.nlm.nih.gov/34922127/
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