成人眶蜂窝织炎的临床进展风险分层预测因素：一项15年队列研究

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中文摘要

目的： 本研究旨在描述成人眶蜂窝织炎（OC）的临床特征、危险因素、影像学模式、微生物学及结局，并识别疾病严重程度和手术干预的预测因素。作者开展了一项回顾性队列研究，纳入2010年1月至2025年3月期间在2个学术中心收治的、年龄大于或等于18岁、经临床和影像学确诊的OC成人患者（n=176）。多变量logistic回归用于识别骨膜下脓肿（SPA）、颅内蔓延（ICE）和手术干预的独立预测因素；χ2检验、方差分析和t检验用于次要分析。平均年龄为47.5±18.8岁，67.6%为男性。17.0%存在糖尿病，且与年龄较大和住院时间较长相关。影像学显示SPA占24.4%，眶内脓肿占10.2%，ICE占4.5%。鼻窦炎和较年轻年龄是SPA的独立预测因素；糖尿病和年龄较大是ICE的独立预测因素。总体而言，58.0%需要手术干预，糖尿病和鼻窦炎为独立预测因素，且同时具有这两种合并症的大多数患者需要手术治疗。近期外伤与更高的手术需求和显著更长的住院时间相关。培养以葡萄球菌属为主（45.8%），其中耐甲氧西林金黄色葡萄球菌占15.0%。真菌分离株仅见于糖尿病宿主。22例患者发生严重视力丧失，5例死亡。成人OC表现出由宿主因素驱动的不同严重程度模式。糖尿病和年龄较大独立预测ICE和手术干预，而鼻窦炎预测较年轻患者的SPA。这些风险特征可能改善分诊、指导经验性抗菌药物选择，并支持及时的外科会诊。

英文摘要

The purpose of this study was to characterize clinical features, risk factors, imaging patterns, microbiology, and outcomes of adults with orbital cellulitis (OC), and to identify predictors of disease severity and surgical intervention. The authors performed a retrospective cohort study of adults greater than or equal to 18 years with clinically and radiographically confirmed OC admitted to 2 academic centers between January 2010 and March 2025 (n=176). Multivariable logistic regression identified independent predictors of subperiosteal abscess (SPA), intracranial extension (ICE), and surgical intervention; χ2 tests, analysis of variance, and t tests were used for secondary analyses. Mean age was 47.5±18.8 years and 67.6% were male. Diabetes was present in 17.0% and was associated with older age and longer hospitalization. Imaging demonstrated SPA in 24.4%, intraorbital abscess in 10.2%, and ICE in 4.5%. Sinusitis and younger age were independent predictors of SPA; diabetes and older age were independent predictors of ICE. Overall, 58.0% required surgical intervention, with diabetes and sinusitis as independent predictors, and most patients with both comorbidities required operative treatment. Recent trauma was associated with greater surgical need and significantly longer length of stay. Staphylococcus spp. predominated on culture (45.8%), with methicillin-resistant S. aureus accounting for 15.0%. Fungal isolates occurred exclusively in diabetic hosts. Severe vision loss occurred in 22 patients, and mortality occurred in 5. Adult OC demonstrates distinct host-factor-driven patterns of severity. Diabetes and older age independently predict ICE and surgical intervention, while sinusitis predicts SPA in younger patients. These risk profiles may improve triage, guide empiric antimicrobial selection, and support timely surgical consultation.