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Jingdong book

嗅觉基础与临床

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嗅觉基础与临床

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《嗅觉基础与临床》一书从嗅觉系统的发育到功能检测、判定,包括介绍大量新技术、新方法用于临床疾病诊断,集目前嗅觉研究、相关疾病诊断之所全,彰显了该书的推广使用价值。作为第一本关于嗅觉的专著,是众多关注嗅觉研究学者们多年来共同努力、汇集大量心血凝集的成果。作者们采用图文并茂的写作方式,使复杂的嗅觉研究变得浅显易懂,便于学习和领悟其中的深奥,加深对嗅觉疾病正确诊断治疗的理解,是一本案头难得的专业参考书。
Author Description

倪道凤,女,江苏盐城人,1970年中国协和医科大学医学系毕业,现任中国医学科学院中国协和医科大学北京协和医院耳鼻咽喉科教授,博士生导师,中华医学会耳鼻咽喉科分会副主任委员,多家杂志的副主编或编委。
Catalogue

基础篇
第一章 嗅觉系统的发育与胚胎学
第二章 嗅觉系统的解剖
第一节 嗅黏膜的解剖
第二节 嗅球的解剖
第三节 嗅觉中枢的解剖

第三章 嗅觉生理学
第一节 嗅觉换能分子神经生理学
第二节 嗅球生理和神经化学
第三节 中枢嗅觉通路的感觉生理
第四节 嗅觉信息的神经编码
第五节 气味记忆

第四章 嗅觉感受遗传学
第五章 嗅黏膜及嗅球的组织病理学研究
第六章 嗅觉通路的可塑性

第七章 三叉神经系统和嗅觉
第一节 化学感觉三叉神经系统解剖
第二节 化学感受三叉神经刺激:人心理物理和生理学研究

第八章 昧感觉和嗅觉的相关性
第一节 嗅觉和味觉的关系
第二节 味觉系统的解剖和生理
第三节 味觉的临床估计
第四节 味觉障碍的分类
第五节 味觉障碍的病因和治疗

临床篇
第一章 嗅觉功能评估
第一节 鼻腔气流空气动力学
第二节 嗅觉心理物理测试
第三节 嗅觉系统结构影像学
第四节 嗅觉功能影像学
第五节 嗅觉事件相关电位
第六节 嗅电图
第七节 嗅黏膜的病理检查

第二章 嗅觉障碍总论
第一节 嗅觉障碍的分类
第二节 嗅觉障碍的病因
第三节 嗅觉障碍的诊断和鉴别诊断
第四节 嗅觉障碍的治疗

第三章 传导性嗅觉障碍
第一节 慢性鼻窦炎和鼻息肉
第二节 变应性鼻炎对嗅觉的影响
第三节 慢性鼻炎
第四节 鼻和鼻窦肿瘤
第五节 鼻腔结构异常对嗅觉的影响
第六节 嗅裂疾病
第七节 鼻中隔成形和鼻成形术

第四章 感觉神经性嗅觉障碍
第一节 先天性失嗅
第二节 外伤后嗅觉障碍
第三节 上呼吸道感染嗅觉障碍
第四节 嗅觉障碍与神经退行性疾病
第五节 特异性失嗅
第六节 多种化学物敏感
第七节 环境毒性物质对嗅觉功能的影响
第八节 嗅觉定性障碍

第五章 混合性嗅觉障碍
第六章 系统性疾病对嗅觉的影响
第一节 肝肾疾病对嗅觉的影响
第二节 甲状腺、甲状旁腺以及肾上腺疾病对嗅觉的影响
第三节 糖尿病对嗅觉的影响
第四节 药物对嗅觉的影响
第五节 抑郁对嗅觉的影响
附录一 中文名词-英文全称-英文缩写对照(基础篇)
附录二 中文名词-英文全称-英文缩写对照(临床篇)
索引
Book Abstract

在神经胶质和嗅球胚基形成后,神经纤维层的轴突束状进入嗅球胚基,在嗅球表层下方与放射状神经胶质细胞混合形成神经纤维小体,它是嗅小球细胞(glomerular cell)的前体。轴突到达嗅小球层的靶区域,延伸形成许多分支与僧帽细胞、丛状细胞、球周细胞的树突形成突触,共同构成嗅小球层。新进入的轴突位于嗅小球层的中央,并不断将旧的轴突挤向周边区域。新的轴突表达GAP-43,它是未成熟嗅感受神经元的标志。成熟的嗅感受神经元表达嗅标记蛋白(olfactorymarkerprotein,OMP)。突触的建立有助于未成熟的神经元发育成熟。在啮齿类动物,嗅上皮大约含有5百万个嗅感受神经元,表达1000~1300个不同的气味受体基因,嗅球含有约2000个嗅小球结构。每一个嗅感受神经元只能特异表达一种气味受体基因,表达相同气味受体基因的嗅感受神经元随机分布在嗅上皮黏膜。嗅感受神经元的轴突向嗅球投射仅与1~4个嗅小球结构形成突触。在嗅小球细胞发育的早期,一个僧帽细胞向嗅小球细胞投射多条树突。在成熟期,一个僧帽细胞仅向嗅小球细胞投射一条树突,即每一个嗅小球细胞与每一个特定僧帽细胞形成突触。突触形成、球周细胞、僧帽细胞、丛状细胞的存在是嗅小球层发育形成的必要条件。嗅感受神经元的轴突对诱导嗅小球层的形成有非常重要的作用。在胚胎第19周,嗅球胚基已经增大延伸,并具有一定的形状。嗅球胚基开始位于室管腔(ventricular cavity)的中央腔与侧脑室之间,中央腔是嗅脑室(olfactory ventricle)的前体,在胚胎发育的过程中存在时间很短,很快消失,而侧脑室永久存在。由于受解剖结构的限制,嗅球胚基向脑室喙侧生长,并向脑室尾侧转移,因此在组织学上不易看见嗅球组织。
二、嗅上皮与嗅球的相互影响
在许多神经系统,神经元的分化发育成熟受它的靶器官的影响,例如:在胚胎期,将运动神经元与肌细胞分离,运动神经元将失活。同样嗅球对嗅感受神经元的分化发育成熟也有重要的影响。对器官培养实验、器官变性实验,器官重塑实验等研究表明,嗅球在嗅感受神经元发育过程中是必需的。将嗅黏膜分离单独移植培养时,嗅感受神经元不能完全分化、成熟,处于分化期的嗅感受神经元能发育生成轴突和带有纤毛的树突柄,也有一些神经元能合成OMP。而将嗅黏膜与嗅球共同培养时,嗅感受神经元表达带有纤毛的树突柄和合成的OMP的数量比单独培养嗅黏膜时多2倍,这表明嗅球对嗅黏膜的发育有一定的影响。对哺乳类动物行单侧嗅球切除后,术侧的嗅感受神经元发生变性,球形基底细胞分化产生新的神经元移行至嗅上皮,但重塑的嗅上皮不完全,较术前变薄,分化成熟的神经元数量明显减少。在切除嗅球侧,嗅上皮的神经元数量比未切除嗅球侧多2倍,但术侧几乎90%的神经元在术后2周死亡。这比神经元在正常嗅上皮的寿命短得多。这是因为神经元分化成熟的营养成分来自嗅球。嗅球切除后,嗅感受神经元不能得到来自嗅球的营养成分,而导致术侧嗅上皮大量新生神经元死亡,重组的嗅上皮变薄,发育不完全。
僧帽细胞对于嗅感受神经元的分化发育也有影响。将构成外侧嗅束的僧帽细胞切除,在嗅上皮可见增殖期的神经元增多,这可能与切除外侧嗅束的僧帽细胞引起的神经元死亡有关。
Introduction

嗅觉——对空气中化学成分气味刺激的感受能力,在低等生物中的重要性非常突出,是关乎规避风险、寻觅食物、交配繁衍等与种系存亡相关的要素。随着生物进化,化学感受器在生存发展中的重要性似被视、听、温度及机械刺激的感受功能所取代,近代生物、生理学对视、听、体感的研究做了大量工作,在临床诊、疗、康复中也得到广泛应用,已是共知的事实,而嗅觉、味觉化学感受器的作用如何?确实长时间被大众忽略了,耳鼻咽喉科医生长期以来,也只把嗅觉作为一个次要的症状。可幸的是科学工作者中有为数不多的尚智者甘心寂寞,契而不舍,在嗅觉的神经生物学基础与临床医学上作了深入研究,长期的苦苦探索获得了突破性进展,Richard Axel和Linda B.Buck两人共获2004年度诺贝尔生理学或医学奖成为一个里程碑式的标志,使气味感受系统结构、机理研究及临床应用由长期处于压抑和不受重视的状态中进发出来,改变了人类嗅觉感受功能弱化和无关紧要的传统观念,揭示出嗅觉感受与人类各种复杂的情绪变化、嗜好趋向、记忆和遗忘及神经系统变性疾病、精神、心理疾病存在密切的关系,还可能成为包括内分泌、消化、循环等系统性疾病的表征。可以预想嗅觉这个在“人之初”时就曾引导新生觅食占有重要地位的最原始化学感受能力,当人类要求有更高质量的环境气氛和情感生活时,会越来越受到重视,在临床医学诊疗与疾病康复过程中会有更广泛的应用。
此次有幸首阅由倪道凤教授牵头,以协和医院嗅觉基础与临床研究队伍为骨干,聚集国内相关专家合力编著的《嗅觉基础与临床》一书,真有茅塞顿开、目光一震的感觉。本书我虽完全读完,但我感觉到它的新颖与厚重。作者们通览国内外可能收到的重要文献资料,结合自身研究成果和工作体会,汇成60余万字、130余图片的专著,开拓了我国在嗅觉研究与应用领域的先河。阅读中感到本书在人体结构与生理学研究(尤其是脑的研究)及其临床应用方面,为读者打开了一扇窗户,为探索开放了一片引人畅游的海洋。在此,我衷心感谢作者们的辛勤劳动,祝贺他们的成功,并兴奋地向从事神经系统结构和生理研究的同道们,向耳鼻咽喉科、神经科、心理学科的同仁和医学生们推荐此书。《嗅觉基础与临床》一书是我国嗅觉研究与应用的宏大开篇,也将成为经典的力作,值得反复阅读、引证和珍藏。

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