目的：探讨光学相干断层扫描血管成像(OCTA)参数和血清半胱氨酸蛋白酶-1(caspase-1)评估糖尿病视网膜病变(DR)严重程度的临床价值。

方法：回顾性纳入2024年6月至2025年12月于我院诊断DR患者，根据眼底荧光血管造影(FFA)结果分为早期非增生型DR(NPDR)和晚期增生型DR(PDR)； 另选择糖尿病非DR患者为对照组。OCTA参数包括黄斑区血流密度、黄斑中心凹无血管区(FAZ)周长和面积、平均视网膜厚度、视网膜高反射点(HRF)以及内界膜异常。血生化包括空腹血糖、糖化血红蛋白(HbA1c)、系统性免疫炎症指数(SII)、三酰甘油/高密度脂蛋白(TG/HDL)、尿微量白蛋白/尿肌酐(UACR)以及caspase-1。

结果：本研究纳入DR患者128例151眼，其中NPDR组75例90眼(男40例，女35例，年龄74.3±5.6岁)，PDR组53例61眼(男27例，女26例，年龄75.9±5.8岁)。对照组60例120眼(男33例，女27例，年龄72.6±5.4岁)。对照组、NPDR组和PDR组黄斑区血流密度逐渐降低，而FAZ周长和面积以及平均视网膜厚度逐渐增加，HRF和内界膜异常发生率逐渐升高(均P<0.001)； SII、UACR和caspase-1水平逐渐增加(均P<0.001)。NPDR组和PDR组糖尿病病程比对照组延长(均P<0.001)。多因素Logistic回归分析显示，糖尿病病程、HRF和caspase-1是DR发生的危险因素，黄斑区血流密度是其保护因素(均P<0.001)； caspase-1是DR进展至PDR的危险因素，黄斑区血流密度是其保护因素(均P<0.001)。受试者工作特征(ROC)曲线显示，caspase-1联合黄斑区血流密度预测DR发生和PDR的曲线下面积(AUC)分别为0.864和0.890，均高于单一指标(均P<0.05)。

结论：OCTA参数黄斑区血流密度联合血清caspase-1对评估DR严重程度具有重要的临床应用价值。

METHODS:Patients diagnosed with DR in our hospital from June 2024 to December 2025 were retrospectively enrolled and were divided into early non-proliferative DR(NPDR)and advanced proliferative DR(PDR)groups according to fundus fluorescein angiography(FFA)findings. Patients with diabetes mellitus but without DR were selected as the control group. OCTA parameters included macular vascular density, the perimeter and area of the foveal avascular zone(FAZ), mean retinal thickness, hyperreflective foci(HRF), and internal limiting membrane abnormalities. Blood biochemical indicators contained fasting blood glucose, glycated hemoglobin(HbA1c), systemic immune-inflammation index(SII), triglyceride/high-density lipoprotein(TG/HDL)ratio, urinary albumin/creatinine ratio(UACR), and caspase-1.

RESULTS: Totally 128 DR patients(151 eyes)were enrolled in this study, including 75 patients(90 eyes)in the NPDR group(40 males and 35 females, mean age: 74.3±5.6 y)and 53 patients(61 eyes)in the PDR group(27 males and 26 females, mean age: 75.9±5.8 y). Meanwhile, 60 diabetic patients(120 eyes)without DR were recruited as the control group(33 males and 27 females, mean age: 72.6±5.4 y).The macular vascular density gradually decreased in the control, NPDR and PDR groups, while perimeter and area of FAZ, and mean retinal thickness gradually increased, and the incidence of HRF and internal limiting membrane abnormalities gradually increased(all PSymbol|@@0.001). The levels of SII, UACR and caspase-1 gradually increased(all PSymbol|@@0.001). The duration of diabetes mellitus was longer in the NPDR and PDR groups than in the control group(all PSymbol|@@0.001).Multivariate logistic regression analysis demonstrated that diabetic duration, HRF, and caspase-1 were risk factors for the occurrence of DR, while macular vascular density served as a protective factor(all P<0.001). Moreover, caspase-1 was identified as a risk factor for the progression of DR to PDR, and macular vascular density was a protective factor against DR progression(all P<0.001). Receiver operating characteristic(ROC)curve analysis showed that the area under the curve(AUC)of caspase-1 combined with macular vascular density for predicting DR occurrence and PDR was 0.864 and 0.890, respectively, both higher than those of single indicators(all PSymbol|@@0.05).

CONCLUSION: The combination of macular vascular density from OCTA parameters and serum caspase-1 has important clinical value in assessing severity of DR.