目的：探讨基于光相干断层扫描血管成像技术(OCTA)观察不同分期糖尿病视网膜病变(DR)患者视网膜神经纤维层厚度(RNFL)、视网膜厚度及血流密度变化。

方法：回顾性分析。选取2023-02/2024-02在我院确诊为DR患者382例382眼，依据分期标准，将患者分为轻度组(121例121眼)、中度组(133例133眼)、重度组(72例72眼)、增生组(56例56眼)，比较四组患者的一般临床资料； 采用OCTA对所有患者进行扫描收集数据，比较四组患者的RNFL、视网膜厚度以及血流密度。

结果：轻度组、中度组、重度组、增生组患者年龄、性别、高血压、慢性肾病、随机血糖比较均无差异(均P>0.05)； 随着DR分期的加重，病程逐渐延长(P<0.05)。RNFL厚度(上方、下方、颞侧、鼻侧、平均厚度)和视网膜厚度均随DR严重程度增加而显著升高(均P<0.001)，中度组与轻度组下方RNFL厚度比较无差异(P>0.05)。视网膜浅层、深层及脉络膜毛细血管层血流密度随DR进展显著降低(均P<0.05)，中度组与重度组视网膜浅层血流密度比较无差异(P>0.05)。

结论：OCTA可精确观察到不同分期DR患者RNFL、视网膜厚度及血流密度的变化，这三者可作为监测DR进展的敏感指标。

METHODS: A retrospective analysis was conducted on 382 patients(382 eyes)diagnosed with DR in our hospital from February 2023 to February 2024. According to the staging criteria, the patients were divided into mild group(n=121), moderate group(n=133), severe group(n=72), and proliferative group(n=56). The general clinical data of the four groups of patients was compared; OCTA was used to scan and collect data from all patients, and the RNFL thickness, retinal thickness, and blood flow density were compared among the four groups of patients.

RESULTS: There was no statistically significant difference in age, gender, hypertension, chronic kidney disease, and random blood glucose among patients in the mild, moderate, severe, and proliferative groups(all P>0.05). As the stage of DR worsened, the duration of the disease gradually prolonged(P<0.05). The thickness of the RNFL(superior, inferior, temporal, nasal, and average thickness)and retinal thickness significantly increased with the severity of DR(all P<0.001); however, there was no statistically significant difference in inferior RNFL thickness between the moderate and mild groups(P>0.05). The blood flow density in the superficial and deep retinal layers, as well as in the choroidal capillary layer, significantly decreased with the progression of DR(all P<0.05). Nevertheless, there was no statistically significant difference in superficial retinal blood flow density between the moderate and severe groups(P>0.05).

CONCLUSION: OCTA can accurately observe the changes in RNFL thickness, retinal thickness, and blood flow density in patients with DR at different stages, which can serve as sensitive indicators for monitoring DR progression.