【目的】研究腹泻型肠易激综合征（IBS-D）的人群特征信息、中医证型分布及其远期预后的影响因素，为IBS-D患者对应干预方案的制定提供数据参考。【方法】选取2020年7月至2022年8月项目组成员所在医疗机构收治的124例IBS-D患者进行研究分析，根据肠易激综合征专用生活质量量表（IBS-QOL）评分结果将所有患者分为预后良好组81例与预后不良组43例。探讨IBS-D患者的中医证型分布，比较预后良好组与预后不良组患者IBS-QOL量表评分结果的差异，并使用单因素分析与多因素Logistic回归分析方法明确IBS-D患者不良预后发生的主要危险因素。【结果】（1）人群特征信息：IBS-D患者男女比例差异不大，发病群体以中年人为主，病程区间跨度较大，疾病症状严重程度多表现为中度，均存在不同程度焦虑与抑郁情绪表现，机体营养水平普遍存在失衡状态。（2）中医证型分布：肝郁脾虚型78例，占62.90%；脾气虚弱型26例，占20.97%；脾肾阳虚型20例，占16.13%。（3）IBS-QOL量表评分：相比预后良好组，预后不良组IBS-QOL量表的负性情绪、躯体功能、行为障碍、健康状态、挑食、社会功能、性行为、人际关系等各项评分均明显降低（P＜0.01）。（4）单因素分析结果显示，年龄、文化程度、病程、症状严重程度、焦虑状态、抑郁状态、中医辨证分型、急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）评分、合并神经系统疾病及血红蛋白水平、白蛋白水平、总蛋白水平改变均可能导致IBS-D患者不良预后风险增加（P＜0.01）。（5）多因素Logistic回归分析结果显示，年龄、文化程度为初中以下、症状严重程度为重度、焦虑自评量表（SAS）评分、抑郁自评量表（SDS）评分、中医辨证分型为肝郁脾虚型及血红蛋白水平、白蛋白水平、总蛋白水平改变均属于IBS-D患者不良预后发生的危险因素（P＜0.01）。【结论】较多的IBS-D患者存在远期不良预后情况，其远期预后情况受诸多因素影响，包括年龄、文化程度、症状严重程度、焦虑与抑郁状态、营养失衡情况以及中医证型为肝郁脾虚型等，明确其不良预后的危险因素可为临床干预方案的制定与调整提供数据参考。

Objective To investigate the population characteristics，distribution of traditional Chinese medicine （TCM）syndromes and influencing factors of long-term prognosis of diarrhea-predominant irritable bowel syndrome（IBS-D），and to provide evidence for the formulation of intervention program for IBS-D patients. Methods A total of 124 patients with IBS-D admitted to the medical institutions of the project team members from July 2020 to August 2022 were selected. According to the scoring results of IBS Quality of Life Measure（IBS-QOL），the patients were divided into the good prognosis group （81 cases）and the poor prognosis group（43 cases）. The distribution of TCM syndromes in patients with IBS-D was explored，and the difference of IBS-QOL scores of the patients between good prognosis group and poor prognosis group was compared. Univariate logistic regression analysis and multivariate logistic regression analysis were used to determine the main risk factors for poor prognosis in patients with IBS-D. Results （1）The analysis of population characteristics showed that there was no significant difference in the proportion of male and female patients with IBS-D. The patients with IBS-D were usually middle-aged，and had a large interval span of the course of disease. The severity of their symptoms was mostly moderate. All of the patients with IBS-D had various degrees of anxiety and depression，and had nutritional imbalance.（2）The distribution of TCM syndromes in the patients with IBS-D were shown as the following：78 cases were identified as liver depression and spleen deficiency type，accounting for 62.90%；26 cases were identified as spleen-qi deficiency type，accounting for 20.97%；20 cases were identified as spleen and kidney yang deficiency type，accounting for 16.13%.（3）Analysis of IBS-QOL score showed that compared with the good prognosis group，the items scores of negative emotion， physical function， behavioral disorder， health status，being fastidious about food，social function，sexual behavior and interpersonal relationship of IBS-QOL in the poor prognosis group were significantly lowered（P＜0.01）.（4）The univariate analysis showed that the risk of poor prognosis in patients with IBS-D would be increased by the factors of age，education level，course of disease，severity of symptoms，anxiety state，depression state，TCM syndrome types，Acute Physiology and Chronic Health Evaluation scoring system II（APACHE II）score，complication of neurological diseases，hemoglobin level，albumin level and total protein level（P＜0.01）. （5）The multivariate Logistic regression analysis showed that the risk factors for poor prognosis of IBS-D patients involved age，education level below junior high school，the severity of symptoms being severe，Self-Rating Anxiety Scale（SAS） score，Self-Rating Depression Scale（SDS）score，TCM syndrome being liver depression and spleen deficiency type，hemoglobin level，albumin level and total protein level（P＜0.01）. Conclusion Most of IBS-D patients exert long-term poor prognosis，and their long-term prognosis is affected by the factors of age，education level，severity of symptoms，anxiety and depression state，nutritional imbalance and TCM syndrome being liver depression and spleen deficiency type. The identification of the risk factors of poor prognosis will provide evidence for the formulation and adjustment of clinical intervention programs.

R259.744

广东省基础与应用基础研究基金自然科学基金面上项目 （编号：20191A1515010673）；东莞市名中医药专家传承工作室项目 （郑学宝东莞市名中医传承工作室）