目的：探究外伤性感染性眼内炎(PTIE)患者病原菌分布特征及与血清巨噬细胞炎症蛋白1α(MIP-1α)、热休克蛋白70(HSP70)、可溶性髓系细胞触发受体1(sTREM-1)水平的关系。

方法：选取邯郸市眼科医院(邯郸市第三医院)2023年5月至2025年5月共157例PTIE患者为研究组，根据出院时裸眼视力分为预后良好组和预后不良组，选取同期157例眼部外伤无眼内感染患者为对照1组，选取同期157例健康体检志愿者为对照2组。采集研究组患者房水和玻璃体液样本检测病原菌分布； 采用酶联免疫吸附法检测血清MIP-1α、HSP70、sTREM-1水平； 多因素Logistic分析预后不良影响因素； 受试者工作特征(ROC)和决策曲线(DCA)分析血清MIP-1α、HSP70、sTREM-1水平对预后不良的预测价值。

结果：三组参与者一般资料具有可比性。PTIE患者157例共检出173株病原菌，以革兰氏阳性菌为主； 研究组血清MIP-1α、sTREM-1水平高于对照1组和对照2组，HSP70水平低于对照1组和对照2组(均P<0.05)，对照2组和对照1组血清MIP-1α、HSP70、sTREM-1水平比较无差异(均P>0.05)。预后不良组PTIE患者伤口缝合时间≥24 h、伤口位置为Ⅱ/Ⅲ区、外伤类型为破裂伤，破裂伤人数占比以及血清C反应蛋白、MIP-1α、sTREM-1水平较预后良好组患者高，HSP70水平降低(均P<0.001)。多因素Logistic分析结果显示，伤口缝合时间、伤口位置、外伤类型、C反应蛋白、MIP-1α、HSP70和sTREM-1是PTIE患者视力预后不良的影响因素(均P<0.05)。ROC曲线结果显示，血清MIP-1α、HSP70、sTREM-1三者联合预测PTIE患者视力预后不良AUC值为0.965，显著大于单独预测(Z_MIP-1α、Z_HSP70、Z_sTREM-1=3.628、4.705、3.930，均P<0.05)，此外由DCA曲线可知联合预测在0.03-0.97高风险阈值的净获益率高于单独预测。

结论：PTIE患者革兰氏阳性菌是感染病原菌主要类型，血清MIP-1α、sTREM-1水平升高，HSP70水平降低，三者联合对患者视力预后恢复效果预测效能较高。

METHODS:A total of 157 patients with PTIE from the Handan City Eye Hospital(The Third Hospital of Handan)from May 2023 to May 2025 were selected as the study group. They were divided into a good prognosis group and a poor prognosis group based on their uncorrected visual acuity at discharge. Meanwhile, 157 patients with ocular trauma but without endophthalmitis during the same period were selected as control group 1, and 157 healthy volunteers who underwent physical examinations during the same period were selected as control group 2. Aqueous humor and vitreous fluid samples were collected from the study group to detect the distribution of pathogens. The levels of serum MIP-1α, HSP70, and sTREM-1 were measured using the enzyme-linked immunosorbent assay. Multivariate Logistic regression analysis was performed to identify risk factors for poor prognosis. The predictive value of serum MIP-1α, HSP70, and sTREM-1 levels for poor prognosis was evaluated using receiver operating characteristic(ROC)and decision curve analysis(DCA).

RESULTS: The general data of the participants in the three groups was comparable. A total of 173 pathogens were detected in the 157 patients with PTIE, with Gram-positive bacteria being the predominant type. The levels of serum MIP-1α and sTREM-1 in the study group were higher than those in control groups 1 and 2, while the level of HSP70 was lower than those in control groups 1 and 2(all P<0.05). There were no significant differences in the levels of serum MIP-1α, HSP70, and sTREM-1 between control groups 1 and 2(all P>0.05). In the poor prognosis group, the time of wound suture was ≥24 h, the wound location was in zones II/III, the type of trauma was rupture, the proportion of rupture injuries, and the levels of serum C-reactive protein, MIP-1α, and sTREM-1 were higher than those in the good prognosis group, while the level of HSP70 was decreased(all P<0.001). Multivariate Logistic regression analysis showed that the time of wound suture, wound location, type of trauma, C-reactive protein, MIP-1α, HSP70, and sTREM-1 were risk factors for poor visual prognosis in patients with PTIE(all P<0.05). The ROC curve results showed that the combined prediction of serum MIP-1α, HSP70, and sTREM-1 for poor visual prognosis in PTIE patients had an AUC value of 0.965, which was significantly higher than that of individual predictions(Z_MIP-1α, Z_HSP70, Z_sTREM-1=3.628, 4.705, 3.930, all P<0.05). Additionally, the DCA curve showed that the combined prediction had a higher net benefit rate than individual predictions in the high-risk threshold range of 0.03-0.97.

CONCLUSION:Gram-positive bacteria are the predominant type of pathogenic bacteria in patients with PTIE, with elevated levels of serum MIP-1α and sTREM-1 and decreased levels of HSP70. The combined detection of these three factors has a high predictive efficacy for visual prognosis in patients.