目的：分析超广域扫描源光学相干断层扫描血管成像(UWF-SS-OCTA)技术，在伴或不伴糖尿病肾病(DKD)的非增殖性糖尿病视网膜病变(NPDR)患者的视网膜及脉络膜中央与周边区域血流密度及厚度变化中的临床实用性与价值。

方法：横断面研究。纳入2023-06/2024-06期间在我院就诊的糖尿病(DM)患者50例50眼。根据是否伴有DKD和视网膜病变分为NPDR合并DKD组(DKD组，20例20眼)、NPDR不合并DKD组(NDKD组，20例20眼)以及DM无视网膜病变组(即单纯DM患者组，DM组，10例10眼，作为对照)。使用UWF-SS-OCTA自带的3×3九宫格分区模式，将扫描24 mm×20 mm范围内的视网膜及脉络膜分为中央及周边区域，并对参数进行定量分析，探讨DKD对NPDR患者眼部微血管病变的影响。

结果：脉络膜毛细血管层(CCP)中央及周边血流密度在DM组和DKD组间(t=3.93，P=0.0003； t=3.34，P=0.0016)、NDKD组和DKD组间(t=-3.06，P=0.003； t=-2.55，P=0.013)有差异，在DM组和NDKD组间无差异(t=1.44，P=0.157； t=1.26，P=0.21)。DM组、NDKD组、DKD组的脉络膜中大血管层(MLCV)中央及周边血流密度逐渐降低(F=13.74、19.03，均P<0.0001)。DM组、NDKD组、DKD组的中央及周边脉络膜厚度(CT)逐渐变薄(F=10.72，P=0.0001； F=13.12，P<0.001)。

结论：CCP、MLCV、CT可作为检测NPDR患者肾功能受损的可视化指标。UWF-SS-OCTA可为DR与DKD联合管理提供科学依据，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。

METHODS: Cross-sectional study. Totally 50 cases(50 eyes)of diabetes mellitus(DM)that visited our hospital between June 2023 and June 2024 were included. They were divided into three groups: NPDR combined with DKD group(DKD group, n=20), NPDR without DKD group(NDKD group, n=20), and DM without retinopathy group(DM group, n=10, which served as control). In order to investigate the impact of DKD on ocular microangiopathy in NPDR patients, the retina and choroid within 24 mm×20 mm of the scan were separated into central and peripheral areas using the 3×3 nine-grid partition option that comes with UWF-SS-OCTA, and the parameters were then quantitatively assessed.

RESULTS:The central and peripheral blood flow density of the choroidal capillary layer(CCP)was statistically significant between the DM group and the DKD group(t=3.93, P=0.0003; t=3.34, P=0.0016), and between the NDKD group and the DKD group(t=-3.06, P=0.003; t=-2.55, P=0.013), but there was no statistically significant difference between the DM group and the NDKD group(t=1.44, P=0.157; t=1.26, P=0.21). The mid-large choroidal vessel(MLCV)showed a progressive decline in central and peripheral blood flow density in the DM, NDKD, and DKD groups(F=13.74, 19.03, all P<0.0001). The DM, NDKD, and DKD groups saw a progressive decrease in central and peripheral choroidal thickness(CT; F=10.72, P=0.0001; F=13.12, P<0.001).

CONCLUSION:CCP, MLCV, and CT can be used as visual indicators to identify impaired renal function in patients with NPDR. UWF-SS-OCTA can support the development of precise and noninvasive monitoring and treatment technology for diabetic ocular microangiopathy, while also offering a scientific foundation for the joint management of DR and DKD.