摘要目的:观察糖尿病患者视网膜结构及功能变化，初步探讨糖尿病视网膜病变（DR）不同病变程度神经组织病变及微血管损伤的变化特征。方法:前瞻性对照研究。2020年5~12月于山东省立医院眼科招募的2型糖尿病患者63例63只眼及同期年龄、性别匹配的健康志愿者40名40只眼（对照组）纳入研究。所有受检者均行光相干断层扫描血管成像（OCTA）、便携式免散瞳视觉电生理诊断系统RETeval检查。采用OCTA测量受检眼视盘周围视网膜神经纤维层（pRNFL）厚度、放射状视盘周围毛细血管丛（RPC）血流密度、黄斑神经节细胞复合体（GCC）厚度。采用RETeval设备的"DR评估方案"模式行闪光视网膜电图检查，记录系统测量的"DR评估得分"。依据早期治疗DR研究制定的DR分级标准对DR进行分级，将糖尿病患者分为无DR （non-DR）组、轻中度非增生型DR （mNPDR）组、重度非增生型DR （sNPDR）组、增生型DR （PDR）组，分别为12、16、18、17只眼。组间pRNFL厚度、GCC厚度、RPC血流密度及"DR评估得分"比较采用单因素方差分析；pRNFL厚度与RPC血流密度之间的相关性采用Pearson相关性分析。结果:与对照组比较，不同程度DR组患眼黄斑GCC整体、上半部分、下半部分厚度明显变薄，差异均有统计学意义（ F=13.560、15.840、5.480， P<0.05 ）。与对照组比较，不同程度DR组患眼pRNFL整体（ F=6.120 ）、上半部分（ F=6.310）、下半部分（ F=5.330 ）、鼻上方（ F=7.350 ）、鼻下方（ F=2.690 ）、上方鼻侧（ F=4.780）、上方颞侧（ F=3.710）、下方颞侧（ F=3.750）厚度变薄，差异有统计学意义（ P<0.05 ）。相关性分析结果显示，视盘整体、上半部分、下半部分、鼻上方、上方鼻侧、下方鼻侧、下方颞侧RPC血流密度与pRNFL厚度呈正相关（ r=0.260、0.256、0.275、0.489、0.444、0.542、0.261， P<0.01 ）。对照组、non-DR组、mNPDR组、sNPDR组、PDR组受检眼"DR评估得分"分别为（12.71±5.62）、（22.18±3.77）、（24.68± 2.41）、（24.98±2.78）、（29.17±7.98）分；DR病变程度越重，评估得分越高，差异有统计学意义（ F=1.535， P<0.01 ）。 结论:与对照组比较，糖尿病患者黄斑GCC、pRNFL厚度以及RPC血流密度明显降低；"DR评估得分"增高，且与DR严重程度相关。

abstractsObjective:To observe the changes in the structure and function of the retina in diabetic patients, and preliminarily explore the changes in the characteristics of neuropathy and microvascular damage in different degrees of diabetic retinopathy (DR).Methods:A prospective controlled study. From May to December 2020, 63 eyes of 63 patients with type 2 diabetes who were recruited from the Department of Ophthalmology of Shandong Provincial Hospital and 40 healthy volunteers with age and sex matching in the same period (control group) were included in the study. All subjects underwent optical coherence tomography angiography (OCTA) and portable non-mydriatic visual electrophysiological diagnosis system RETeval. OCTA was used to measure the thickness of the retinal nerve fiber layer (pRNFL) around the optic disc, the blood flow density of theradial peripapillary capillary (RPC) around the optic disc, and the thickness of the macular ganglion cell complex (GCC). The "DR evaluation plan" mode of the RETeval device was used to perform flash electroretinogram examination, and the "DR evaluation score" measured by the system was recorded. According to the DR grading standard established in the early treatment of DR research, DR was classified. Diabetic patients were divided into non-DR (non-DR) group, mild to moderate non-proliferative DR (mNPDR) group, and severe non-proliferative DR (sNPDR) group, Proliferative DR (PDR) group, with 12, 16, 18, and 17 eyes respectively. The comparison of pRNFL thickness, GCC thickness, RPC blood flow density and "DR assessment score" between groups was performed by one-way analysis of variance; the correlation between pRNFL thickness and RPC blood flow density was analyzed by Pearson correlation analysis.Results:Compared with the control group, the overall, upper and lower thickness of the macular GCC of the affected eyes in different degrees of DR groups were significantly thinner, and the difference was statistically significant ( F=13.560, 15.840, 5.480; P<0.05). Compared with the control group, the overall pRNFL ( F=6.120), upper part ( F=6.310), lower part ( F=5.330), upper nose ( F=7.350), lower nose ( F=2.690), the upper nasal side ( F=4.780), the upper temporal side ( F=3.710), and the lower temporal side ( F=3.750) became thinner, the difference was statistically significant ( P<0.05). Correlation analysis results showed that the whole optic disc, upper part, lower part, upper nose, upper nasal side, lower nasal side, and lower temporal RPC blood flow density were positively correlated with pRNFL thickness ( r=0.260, 0.256, 0.275, 0.489, 0.444, 0.542, 0.261; P<0.01). The "DR evaluation scores" of the eyes in the control group, non-DR group, mNPDR group, sNPDR group, and PDR group were 12.71±5.62, 22.18±3.77, 24.68±2.41, 24.98±2.78, 29.17±7.98 points; the DR lesions were more severe, the evaluation score were higher, and the difference was statistically significant ( F=1.535, P<0.01). Conclusion:Compared with the control group, the macular GCC, pRNFL thickness and RPC blood flow density of diabetic patients are significantly reduced; the "DR evaluation score" is increased, and it is related to the severity of DR.