摘要：目的：本研究旨在利用超广域扫描源光学相干断层扫描血管成像（Ultra-Wide-Field Swept-Source Optical Coherence Tomography Angiography, UWF-SS-OCTA）技术，对伴有或不伴有糖尿病肾病（Diabetic Kidney Disease, DKD）的非增殖期糖尿病性视网膜病变（Non-Proliferative Diabetic Retinopathy, NPDR）患者的视网膜及脉络膜中央与周边区域的血流密度及厚度变化进行定量分析。通过此分析，评估UWF-SS-OCTA在监测伴有DKD的NPDR患者眼部微血管病变中的临床实用性与价值。方法：横断面研究。纳入2023年6月至2024年6月期间在山东第二医科大学附属医院就诊的50例糖尿病患者。根据病情分组，包括NPDR合并DKD组（DKD组，n=20）、NPDR不合并DKD组（NDKD组，n=20）以及糖尿病无视网膜病变组（NDR组，n=10，作为对照）。所有入选患者均接受UWF-SS-OCTA检查，以获取其视网膜及脉络膜中央与周边区域的血流密度与厚度数据，包括浅层视网膜（superficial capillary plexuses, SCP）、深层视网膜（deep capillary plexus, DCP）、脉络膜毛细血管层（choroidal capillary plexus, CCP）及脉络膜中大血管层（mid-large choroidal vessel, MLCV）的血流密度（vessel density, VD）和浅层视网膜厚度（superficial retina thickness, SRT）、深层视网膜厚度（deep retina thickness, DRT）及脉络膜厚度（choroid thickness, CT）。随后，对这些参数进行定量分析，以探讨各组之间的差异及DKD对NPDR患者眼部微血管病变的影响。结果：（1）与NDKD组比，DKD组患者估算的肾小球滤过率更低且尿白蛋白/肌酐比值更高（P<0.05）。（2）NDR组、NDKD组和DKD组在视网膜SCP周边区域的血流密度、DCP中央和周边区域的血流密度逐渐降低（P<0.05），SCP中央区域的血流密度在NDR组和DKD组间、NDKD组和DKD组间存在统计学差异（P<0.05），在NDR组和NDKD组间无统计学差异（P>0.05）。（3）NDR组、NDKD组和DKD组在脉络膜MLCV中央和周边区域的血流密度逐渐降低（P<0.05），CCP中央和周边区域的血流密度在NDR组和DKD组间、NDKD组和DKD组有统计学差异（P<0.05），在NDR组和NDKD组间无统计学差异（P>0.05）。（4）NDR组、NDKD组和DKD组的中央和周边区域的脉络膜厚度均逐渐变薄（P<0.05），视网膜SRT和DRT的中央和周边区域在NDR组和DKD组有统计学差异（P<0.05），而在NDR组和NDKD组间、NDKD组和DKD组无统计学差异（P>0.05）。结论：（1）伴DKD的NPDR患者CCP的血流密度下降明显，提示CCP血流密度的下降可能与发生DKD的风险增加有关。（2）伴DKD的NPDR患者的MLCV的血流密度明显下降，表明MLCV层的血流密度可被选为监测糖尿病肾病患者脉络膜微脉管系统损伤的可视化指标。（3）脉络膜厚度的明显减少可能提示NPDR患者的肾功能受损。（4）本研究将为UWF-SS-OCTA在糖尿病视网膜病变与糖尿病肾病联合管理中的应用提供科学依据，进一步推动糖尿病眼部微血管病变的无创、精准监测与治疗技术的发展。

Abstract: OBJECTIVE: This study aims to utilize Ultra-Wide-Field Swept-Source Optical Coherence Tomography Angiography (UWF-SS-OCTA) technology to quantitatively analyze the changes in blood flow density and thickness in the central and peripheral regions of the retina and choroid in patients with Non-Proliferative Diabetic Retinopathy (NPDR) with or without Diabetic Kidney Disease (DKD). Through this analysis, we evaluate the clinical utility and value of UWF-SS-OCTA in monitoring microvascular lesions in NPDR patients with DKD.METHODS: A cross-sectional study was conducted, including 50 diabetic patients who visited Shandong Second Medical University Affiliated Hospital from June 2023 to June 2024. Patients were divided into three groups based on their clinical conditions: NPDR with DKD group (DKD group, n=20), NPDR without DKD group (NDKD group, n=20), and diabetes without retinopathy group (NDR group, n=10, as a control). All enrolled patients underwent UWF-SS-OCTA examinations to obtain data on blood flow density and thickness in the central and peripheral regions of the retina and choroid. This included measurements of the superficial capillary plexuses (SCP), deep capillary plexus (DCP), choroidal capillary plexus (CCP), and mid-large choroidal vessel (MLCV) for vessel density (VD), as well as superficial retina thickness (SRT), deep retina thickness (DRT), and choroid thickness (CT). These parameters were then quantitatively analyzed to explore differences between groups and the impact of DKD on microvascular lesions in NPDR patients.RESULTS: (1) Compared to the NDKD group, the DKD group exhibited a significantly lower estimated glomerular filtration rate and a higher urine albumin-to-creatinine ratio (P<0.05). (2) Blood flow density in the peripheral region of the retina's SCP, as well as in the central and peripheral regions of the DCP, progressively decreased across the NDR, NDKD, and DKD groups (P<0.05). Statistically significant differences in the blood flow density of the SCP central region were observed between the NDR and DKD groups, and between the NDKD and DKD groups (P<0.05), but no statistical difference was found between the NDR and NDKD groups (P>0.05). (3) Blood flow density in the central and peripheral regions of the MLCV decreased progressively across the NDR, NDKD, and DKD groups (P<0.05), while significant differences in CCP blood flow density were noted between the NDR and DKD groups, and between the NDKD and DKD groups (P<0.05), with no differences between the NDR and NDKD groups (P>0.05). (4) Choroidal thickness in both central and peripheral regions decreased significantly in all three groups (P<0.05). The central and peripheral SRT and DRT showed statistically significant differences between the NDR and DKD groups (P<0.05), while no significant differences were observed between the NDR and NDKD groups, or between the NDKD and DKD groups (P>0.05).CONCLUSION: (1) The blood flow density of the CCP in NPDR patients with DKD is significantly decreased, suggesting that the reduction in CCP blood flow density may be associated with an increased risk of developing DKD. (2) The significant decrease in MLCV blood flow density in NPDR patients with DKD indicates that MLCV blood flow density could be a viable indicator for monitoring damage to the choroidal microvascular system in patients with diabetic kidney disease.(3) The marked reduction in choroidal thickness may indicate impaired renal function in NPDR patients.(4) This study provides scientific evidence for the application of UWF-SS-OCTA in the combined management of diabetic retinopathy and diabetic kidney disease, further promoting the development of non-invasive and precise monitoring and treatment technologies for diabetic ocular microvascular lesions.