目的：利用超高速扫频源光学相干断层扫描血管成像(SS-OCTA)测量脉络膜毛细血管(CC)灌注密度(PFD)评估不同糖尿病视网膜病变(DR)患者脉络膜毛细血管血流特征。方法：横断面研究。选取2022-03/12在合肥市第二人民医院就诊的受试者139例139眼：包括糖尿病患者115例115眼和对照组24例24眼。根据早期糖尿病视网膜病病变研究(ETDRS)标准对彩色视网膜图像进行DR分级，将糖尿病患眼分为无DR组、非增殖性糖尿病视网膜病变(NPDR)组、NPDR合并糖尿病黄斑水肿(DME)组、增殖性糖尿病视网膜病变(PDR)组。采用超高速SS-OCTA设备扫描以黄斑中央凹为中心3mm×3mm的区域，利用系统内置软件测量CC灌注面积，计算PFD，采用多元线性回归评估CC的PFD与DR程度的相关性。结果：DR程度与CC血流灌注相关，调整各种混杂因素后，与对照组相比，NPDR组中心凹CC的PFD减少9.358个单位(95%CI -18.484～-0.232，P=0.045)，旁中心凹减少9.284个单位(95%CI -18.487～-0.090，P=0.048)； NPDR合并DME组中心凹CC PFD减少18.173个单位(95%CI -28.583～-7.762，P=0.001)，旁中心凹减少17.032个单位(95%CI -27.521～-6.544，P=0.002)； PDR组中心凹CC PFD减少28.309个单位(95%CI -39.978～-16.640，P<0.001)，旁中心凹减少25.841个单位(95%CI -37.597～-14.085，P<0.001)。结论：超高速SS-OCTA测量CC血流密度可以客观量化黄斑灌注，黄斑区CC血流灌注密度与DR严重程度相关，随着DR进展黄斑区CC灌注密度降低，未来纵向研究可阐明CC灌注与DR进展之间的因果关系。

AIM: To evaluate the characteristics of choriocapillary blood flow in different patients with diabetic retinopathy(DR)based on the measurement of choriocapillaris(CC)perfusion density(PFD)using ultra-high-speed swept-source optical coherence tomography angiography(SS-OCTA)METHODS: The cross-sectional observational study was conducted on 139 cases(139 eyes)who admitted to the Second People's Hospital of Hefei, including 115 DR cases(115 eyes)and 24 control cases(24 eyes). The color retinal images were graded according to the Early Treatment Diabetic Retinopathy Study(ETDRS)scale, and the DR eyes were classified into non-DR group, nonproliferative diabetic retinopathy(NPDR)group, NPDR combined with diabetic macular edema(DME)group and proliferative diabetic retinopathy(PDR)group. The ultra-high-speed SS-OCTA was used to scan a 3mm×3mm region centered on the macular central fovea, the CC perfusion area was measured by the built-in software, and PFD was calculated. Multivariable linear regressions were used to evaluate the correlation between PFD of CC and DR degree.RESULTS: The degree of DR had a correlation with blood perfusion of CC after adjusting for various confounding factors. When compared to the control group, the PFD of CC in the central fovea of the NPDR group decreased by 9.358 units(95%CI -18.484～-0.232, P=0.045)and 9.284 units in the paracentral fovea(95%CI -18.487～-0.090, P=0.048); In the NPDR combined with DME group, the central fovea CC PFD decreased by 18.173 units(95%CI -28.583～-7.762, P=0.001), while the paracentral fovea decreased by 17.032 units(95%CI -27.521～-6.544, P=0.002); In the PDR group, the central fovea CC PFD decreased by 28.309 units(95%CI -39.978～-16.640, P<0.001), while the paracentral fovea decreased by 25.841 units(95%CI -37.597～-14.085, P<0.001).CONCLUSION: The macular perfusion can be objectively quantified by the measurement of CC PFD with ultra-high-speed SS-OCTA. The CC PFD in the macular region was significantly reduced in more advanced stages of DR. Furthermore, future research should focus on longitudinal studies in the causal relationship between CC perfusion and DR progression.

合肥市第二人民医院博士学位专项资助基金(No.2022bszx04); 合肥市第二人民医院院级科研项目(No.2023ylc009)