方法：前瞻性研究。选取我院2017-06/2019-12期间收治的84例98眼DR患者为研究组，进一步根据DR程度分为非增生型DR组和增生型DR组，另选取60例68眼同期于我院体检的单纯性糖尿病患者为对照组。采用OCTA定量分析受试者的视网膜黄斑区微血管，采用自带分析软件获得浅层、深层旁中心凹视网膜的血流密度(SCP、DCP)、黄斑中心凹无血管区域(FAZ)面积以及周长、非圆指数(AI)、全层视网膜血流密度(FD-300)。比较各组间定量指标差异以及OCTA参数与DR严重程度的相关性和对DR的诊断价值。

结果：研究组的FD-300、SCP、DCP均低于对照组(t=6.476、8.907、5.078，均P<0.05)，而FAZ周长和AI高于对照组(t=4.380、10.542，均P<0.05)。增生型DR组的FD-300、SCP、DCP均低于非增生型DR组(t=2.668、3.408、3.103，均P<0.05)，而FAZ周长和AI高于非增生型DR组(t=2.550、5.563，均P<0.05)。Pearson相关性分析显示，FD-300、SCP、DCP与疾病严重程度呈负相关性(r=-0.485、-0.546、-0.522，均P<0.05)，FAZ周长、AI与疾病严重程度呈正相关性(r=0.426、0.443，均P<0.05)。ROC曲线分析显示，FD-300、SCP、DCP、FAZ周长、FAZ形态指数诊断DR的曲线下面积分别为0.835(95%CI：0.722～0.947)、0.806(95%CI：0.701～0.911)、0.849(95%CI：0.770～0.928)、0.768(95%CI：0.641～0.896)、0.742(95%CI：0.633～0.850)。

结论：OCTA可清晰监测DR患者视网膜黄斑区浅层、深层毛细血管形态，血流密度定量指标与疾病严重程度呈负相关性，对于DR的诊断具有较高的临床价值。

METHODS: Prospective research. The 84 patients(98 eyes)with DR admitted to our hospital during 2017-06/2019-12 were selected as the study group, and were further divided into non-proliferative DR group and proliferative DR group according to the degree of DR. Another 60 cases(68 eyes)with simple diabetes mellitus who underwent physical examination in our hospital during the same period were selected as the control group. The OCTA was used to quantitatively analyze the microvessels in the retinal macular area of the subject, and the built-in analysis software was used to obtain the blood flow density(SCP, DCP)of the superficial and deep parafoveal retina, the area and circumference of the foveal avascular zone(FAZ), the roundness index, full-thickness retinal blood flow density(FD-300). The differences of quantitative indexes, the correlation between OCTA parameters and DR severity and the diagnostic value of DR were compared.

RESULTS: The study group's FD-300, SCP and DCP were lower than those of the control group(t=6.476, 8.907, 5.078; all P<0.05), while the FAZ circumference and the roundness index were higher than those of the control group(t=4.380, 10.542; all P<0.05). The FD-300, SCP and DCP of the proliferative DR group were lower than those of the non-proliferative DR group(t=2.668, 3.408, 3.103; all P<0.05), while the FAZ circumference and the roundness index were higher than those of the non-proliferative DR group(t=2.550, 5.563; all P<0.05). Pearson correlation analysis shows that FD-300, SCP, DCP were negatively correlated with disease severity(r= -0.485, -0.546, -0.522; all P<0.05), FAZ circumference and morphological index were positively correlated with disease severity(r=0.426, 0.443; all P<0.05). ROC curve analysis showed that the area under the curve for FD-300, SCP, DCP, FAZ circumference, and FAZ morphological index to diagnose DR were 0.835(95%CI: 0.722-0.947), 0.806(95%CI: 0.701-0.911), 0.849(95%CI: 0.770-0.928), 0.768(95%CI: 0.641-0.896), 0.742(95%CI: 0.633-0.850), respectively.

CONCLUSION: OCTA can clearly monitor the morphology of superficial and deep capillaries in the macular area of patients with DR. The quantitative index of blood flow density is negatively correlated with the severity of the disease, which has high clinical value for the diagnosis of DR.