多模态影像的非增殖期糖尿病视网膜病变进展风险分层研究综述

A Review of Multimodal Imaging-Based Risk Stratification for Progression in Non-Proliferative Diabetic Retinopathy

摘要: 非增殖期糖尿病视网膜病变(Non-Proliferative Diabetic Retinopathy, NPDR)的进展在临床中存在着明显的个体差异，在临床随访决策中有很多不确定性。多模态影像的迅速发展为我们从视网膜结构与微血管灌注层面理解这种差异提供了新的视角。传统的糖尿病视网膜病变早期治疗研究(Early Treatment Diabetic Retinopathy Study, ETDRS)分级体系在群体中的评估有着重要的参考价值，但在个体层面这个体系的预测能力是有限的。通过光学相干断层扫描(Optical Coherence Tomography, OCT)、光学相干断层扫描血管成像(Optical Coherence Tomography Angiography, OCTA)、超广角成像(Ultra-Widefield Imaging, UWF)等技术获得的定量参数既能反映眼底的当前病理状态，也包含有关未来进展风险的重要信号，逐步将影像学特征整合用于风险分层，能够在传统分级之外更准确地识别出高危个体，从而为随访频率与干预时机的制定提供参考，但其最终价值还需通过更大规模的前瞻性研究与真实世界验证来进一步明确。

Abstract: There are obvious individual differences in the progress of non-proliferative diabetic retinopathy (NPDR) in clinic, and there are many uncertainties in clinical follow-up decision. The rapid development of multimodal images provides us with a new perspective to understand this difference from the aspects of retinal structure and microvascular perfusion. The traditional grading system of Early Treatment Diabetic Retinopathy Study (ETDRS) has important reference value in the evaluation of the population, but its predictive ability is limited at the individual level. Optical coherence tomography (OCT), optical coherence tomography angiography (OCTA), ultra-widefield imaging (UWF) and other technologies can not only reflect the current pathological state of the fundus, but also contain important signals about the risk of future progress. Gradually integrating imaging features into risk stratification can identify high-risk individuals more accurately than traditional classification, thus providing reference for the formulation of follow-up frequency and intervention opportunity, but its final value needs to be further clarified through larger-scale prospective research and real-world verification.