目的：探讨黄斑区微血管密度与糖尿病性黄斑水肿(DME)患者抗血管内皮生长因子(VEGF)治疗反应的关系。

方法：回顾性病例对照研究。收集2021年1月至2025年8月在我院接受抗VEGF治疗的DME患者的临床资料，所有患者均接受玻璃体腔内注射抗VEGF治疗，每月1次，共3次。根据抗VEGF治疗反应分为反应良好组与反应不良组。比较两组患者治疗前浅层毛细血管丛(SCP)、深层毛细血管丛(DCP)的血管密度。采用多因素Logistic回归分析影响DME患者抗VEGF治疗反应的因素。绘制受试者工作特征(ROC)曲线，分析治疗前SCP血管密度和DCP血管密度对DME患者抗VEGF治疗反应的预测价值。

结果：本研究共纳入DME患者315例315眼，其中男172例，女143例，年龄46-78(平均62.06±7.38)岁。完成3次治疗后反应良好组211例211眼中男114例，女97例，平均年龄61.92±7.52岁； 反应不良组104例104眼中男58例，女46例，平均年龄62.35±7.10岁。反应不良组患者糖尿病病程长于反应良好组、治疗前中心视网膜厚度大于反应良好组、治疗前糖化血红蛋白(HbA1c)水平高于反应良好组、病变类型为浆液性视网膜脱离的患者占比高于反应良好组、治疗前SCP血管密度和DCP血管密度均低于反应良好组(均P<0.001)。多因素Logistic回归分析显示，治疗前HbA1c、病变类型为浆液性视网膜脱离、治疗前SCP血管密度和DCP血管密度均为影响DME患者抗VEGF治疗反应的因素(均P<0.05)； 绘制ROC曲线结果显示，治疗前SCP血管密度、治疗前DCP血管密度单独及联合预测DME患者抗VEGF治疗反应不良的曲线下面积(AUC)分别为0.812、0.797、0.901，均有较高预测价值。

结论：黄斑区微血管密度与DME患者抗VEGF治疗反应密切相关，治疗前SCP和DCP的血管密度可作为预测治疗反应的重要指标，临床可针对性给予预防和治疗措施。

METHODS: Retrospective case-control study. Clinical data of DME patients who received anti-VEGF treatment in the hospital from January 2021 to August 2025 were collected. All patients received intravitreal anti-VEGF treatment once a month for a total of 3 times. The patients were divided into the good response group and the poor response group based on the anti-VEGF treatment response. The vascular density of superficial capillary plexus(SCP)and deep capillary plexus(DCP)were compared between the two groups before treatment. Multivariate logistic regression models were used to analyze the factors affecting the anti-VEGF treatment response in DME patients. The receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of SCP and DCP vascular density for anti-VEGF treatment response in DME patients.

RESULTS: The study included a total of 315 DME patients 315 eyes, including 172 males and 143 females with the mean age of 62.06±7.38 y. After completing three treatments, there were 211 cases 211 eyes in the good response group, including 114 males and 97 females with the mean age of 61.92±7.52 y. There were 104 cases in the poor response group, including 58 males and 46 females with the mean age of 62.35±7.10 y. The course of diabetes in the poor response group was longer than that in the good response group, the central retinal thickness before treatment was greater than that in the good response group, the level of glycosylated hemoglobin(HbA1c)before treatment was higher than that in the good response group, and the proportion of patients with serous retinal detachment was higher than that in the good response group. Before treatment, the vascular density of SCP and DCP in the poor response group was lower than that in the good response group(all P<0.01). Multivariate Logistic regression analysis showed that SCP and DCP vascular density were both influencing factors of anti-VEGF treatment response in DME patients(both P<0.05). ROC curves showed that the area under the curve(AUC)of the pre-treatment SCP vascular density, pre-treatment DCP vascular density alone, and their combined model for predicting poor response to anti-VEGF therapy in DME patients were 0.812, 0.797 and 0.901, respectively, indicating high predictive value.

CONCLUSION: The microvascular density in the macular area is closely related to the anti-VEGF treatment response in DME patients. The vascular density of SCP and DCP before treatment can be used as important indicators to predict treatment response, and targeted preventive and therapeutic interventions can be adopted in clinical practice.