【目的】探讨不同性别、年龄缺血性脑卒中 （ischemic stroke，IS） 人群的舌脉象及中医证候要素分布特点，为脑卒中的防治提供中医思路。【方法】采用《缺血性中风证候要素诊断量表》的6种证候要素对深圳市中医院2017～2023年初次就诊确诊缺血性脑卒中的5 254例住院患者进行综合辨识，并收集患者出现频次前5位的舌质、舌苔、脉象进行比较和分析。【结果】（1） 5 254例缺血性脑卒中患者的中医证候要素分布以痰湿证 （3 544例，67.5%） 为主，其次主要为气虚证 （653例，12.4%） 和阴虚证 （453例，8.6%） 。男女性别在痰湿证、内火证、阴虚证的差异有统计学意义 （P＜0.01） 。青年与中老年在痰湿证、气虚证、内风证、内火证的分布情况比较，差异均有统计学意义 （P＜0.01） 。 （2） 缺血性脑卒中检出率前6位的舌脉象按出现频率由高到低依次为：舌质暗淡 （1 993例，37.9%） 、舌质暗红 （1 907 例，36.3%） 、苔薄白 （1 885例，35.9%） 、脉弦滑 （1 714例，32.6%） 、苔白腻 （1 679 例，32.0%） 、脉弦细 （1 609例，30.6%） 。舌质淡红、苔薄白等舌脉象检出率青年组显著高于中老年组，舌质暗红、齿痕等舌脉象检出率中老年组显著高于青年组，差异均有统计学意义 （P＜0.05） 。舌质暗淡、苔薄白、苔薄黄、脉弦细、脉沉细等舌脉象检出率女性显著高于男性，舌质暗红、舌质红、苔白腻、苔黄厚腻、苔白厚腻、脉弦滑、脉滑等舌脉象检出率男性显著高于女性，差异均有统计学意义 （P＜0.05或P＜0.01） 。苔薄白的检出率青年女性显著高于青年男性，脉弦滑的检出率青年男性显著高于青年女性，差异均有统计学意义 （P＜0.05或P＜0.01） ；舌质暗淡、苔薄白、脉弦细、脉沉细的检出率中老年女性显著高于中老年男性，舌质暗红、舌质红、苔白腻、苔白厚腻、苔黄厚腻、脉弦滑、脉滑的检出率中老年男性显著高于中老年女性，差异均有统计学意义 （P＜0.05或P＜0.01） 。 【结论】痰湿证、气虚证、阴虚证对缺血性脑卒中的影响显著，且以痰湿证为主；性别、年龄等因素影响着缺血性脑卒中患者的中医证候分布。

Objective To explore the distribution patterns of tongue and pulse manifestations and traditiona Chinese medicine （TCM） syndrome elements in ischemic stroke （IS） patients of different genders and ages，thus to provide approaches for the prevention and treatment of stroke with TCM. Methods The criteria of six syndrome elements in Diagnostic Scale of Syndrome Elements in Ischemic Stroke were used for the comprehensive identification of syndrome elements in 5 254 cases of inpatients confirmed as IS at the first visit in Shenzhen Traditional Chinese Medicine Hospital from 2017 to 2023. Moreover，the tongue proper，tongue coating，and whose pulse manifestations ranking in the top five in terms of the frequency of occurrence were collected forcomparison and analysis. Results （1） For the distribution of TCM syndrome elements in 5 254 cases of IS patients，phlegm-dampness syndrome was the most common syndrome type（3 544 cases，67.5%），and then came qi deficiency syndrome （653 cases，12.4%） and yin deficiency syndrome （453 cases，8.6%） . There were statistically significant differences in the distribution of phlegm-dampness syndrome， internal heat syndrome， and yin deficiency syndrome between the male and the female（P＜0.01） . And the distribution of phlegm-dampness syndrome，qi deficiency syndrome，internal wind syndrome，and internal heat syndrome in the youth differed from that in the middle-aged and elderly （P＜0.01） . （2）The tongue and pulse manifestations in IS patients with the leading six detection rates which ranked in descending order of frequency of occurrence were as follows：dull tongue （1 993 cases，37.9%），dark red tongue（1 907 cases，36.3%），thin and white coating（1 885 cases，35.9%） ，wiry and slippery pulse （1 714 cases，32.6%） ，white and greasy coating （1 679 cases，32.0%） ，and wiry and thready pulse （1 609 cases，30.6%） . The detection rates of tongue and pulse manifestations such as light red tongue，thin and white coating in the youth group were significantly higher than those in the middle-aged and elderly group，and the detection rates of dark red tongue，and tooth-marked tongue in the middle-aged and elderly group were significantly higher than those in the youth group， the differences all being statistically significant （P＜0.05） . The female patients had higher detection rates of dull tongue，thin and white coating，thin and yellow coating，wiry and thready pulse，and deep and thready pulse than male patients，while the male patients had higher detection rates of dark red tongue，red tongue，white and greasy coating，yellow and thick-greasy coating，white and thick-greasy coating，wiry and slippery pulse，and slippery pulse than the females，and the differences were all statistically significant（P＜0.05 or P＜0.01） . Higher detection rate of thin and whitecoating was shown in the youth female than that in the youth male，while higher detection rate of wiry and slippery pulse was shown in the youth male than that in the youth female， and the differences were all statistically significant （P＜0.05 or P＜0.01） . The middle-aged and elderly female patients had higher detection rates of dull tongue，thin and white coating，wiry and thready pulse，and deep and thready pulse than the middle-aged and elderly male patients，while the middle-aged and elderly male patients had higher detection rates of dark red tongue，red tongue，white and greasy coating，white and thick-greasy coating，yellow and thick-greasy coating，wiry and slippery pulse，and slippery pulse than the middle-aged and elderly female patients，the differences being all statistically significant （P＜0.05 or P＜0.01） . Conclusion Phlegm-dampness syndrome，qi deficiency syndrome，and yin deficiency syndrome exert a significant effect on IS，and phlegm-dampness syndrome is the most common syndrome type. Factors such as gender and age have influences on the distribution of TCM syndrome in patients with IS.

R277.7

国家自然科学基金青年基金项目 （编号：81803952)