【目的】 探讨慢性心力衰竭（CHF）患者的中医证素特征及其与远期预后的相关性，为临床治疗 CHF 提供客观依据。 【方法】 回顾性收集2006年1月至2014年7月于中国中医科学院广安门医院心内科诊断为CHF的546例患者的四诊资料，确 定中医证素特征，并进行最长为期1 330 d的随访，记录患者的远期预后情况，终点事件为研究对象死亡，并根据终点事件 情况，将患者分为存活组 291例和死亡组 255例。观察 2组患者的中医证素分布情况，比较 2组患者的中医证素组合规律的 差异，分析 CHF 患者远期预后与中医证素特征的相关性。【结果】（1）死亡组患者的年龄大于存活组，血清 N 末端前脑钠肽 （NT-proBNP）水平高于存活组，差异均有统计学意义（P＜0.01）；美国纽约心脏病学会（NYHA）心功能分级方面，死亡组患 者的心功能Ⅲ级比例少于存活组，心功能Ⅳ级比例多于存活组，差异均有统计学意义（P＜0.05或 P＜0.01）；心脏超声指标 方面，2组患者的左心室射血分数（LVEF）、左心室舒张末期直径（LVEDD）和右心室舒张末期直径（RVEDD）比较，差异均有 统计学意义（P＜0.05或P＜0.01），而2组患者的左心房直径（LA）比较，差异无统计学意义（P＞0.05）；基础疾病方面，死亡 组患者的冠心病比例（87.45%）高于存活组（80.76%），差异有统计学意义（P＜0.05），其余基础疾病比较，差异均无统计学意 义（P＞0.05）。（2）死亡组患者气虚、阴虚证素多于存活组，而气滞证素少于存活组，差异均有统计学意义（P＜0.05 或 P＜ 0.01）；死亡组患者的气虚阴虚血瘀、阳虚血瘀痰热、气虚阴虚痰热和阳虚血瘀痰浊证素比例多于存活组，差异均有统计学 意义（P＜0.05或 P＜0.01）。【结论】 CHF可以有阴虚、阳虚两种转归，死亡组患者气虚阴虚血瘀证和阳虚血瘀痰浊证占比较 存活组多，预后不佳，临床应予以重视并进行早期干预，避免不良事件的发生。

Objective To explore the characteristics of traditional Chinese medicine （TCM） syndrome elements in patients with chronic heart failure （CHF） and their correlation with long-term prognosis， thus to provide an objective basis for clinical treatment of CHF. Methods From January 2006 to July 2014，a retrospective analysis was carried out in 546 patients diagnosed as CHF in the Cardiology Department of Guang’anmen Hospital，China Academy of Chinese Medical Sciences. TCM syndrome elements of the patents were determined based on the data collected by four diagnostic methods. Patients were followed up for a maximum of 1 330 days， and long-term prognosis was recorded. With the patient’s death as the endpoint event， and the patients were divided into a survival group （291 cases） and a death group （255 cases） according to the endpoint event. The distribution of TCM syndrome elements in the two groups was observed，and differences in the combination patterns of TCM syndrome elements were compared. After that，the correlation between long-term prognosis and TCM syndrome elements in CHF patients was analyzed. Results （1） The age of patients in the death group was greater and serum N-terminal pro-brain natriuretic peptide （NT-proBNP） level was higher than that in the survival group，the differences being statistically significant （P＜0.01）. In terms of New York Heart Association （NYHA） functional classification，the patients of death group had low proportion of heart function level III while high proportion of heart function level Ⅳ in comparison with the patients of survival group，the differences being statistically significant（P＜0.05 or P＜ 0.01）. Statistically significant differences were presented in the cardiac ultrasound indicators of left ventricular ejection fraction （LVEF），left ventricular end-diastolic diameter（LVEDD），and right ventricular end-diastolic diameter（RVEDD） between the two groups（P＜0.05 or P＜0.01）， while left atrial diameter （LA） showed no significant difference between the two groups（P＞0.05）. In terms of underlying diseases， the proportion of coronary heart disease in the death group （87.45%） was higher than that in the survival group （80.76%），with a statistically significant difference（P＜0.05）. No significant differences were presented in other underlying diseases （P＞0.05）.（2） The death group had more cases of qi deficiency and yin deficiency syndrome elements while less cases of qi stagnation syndrome element than the survival group，and the differences were statistically significant （P＜0.05 or P＜0.01）. The death group had higher proportions of syndrome element combinations such as qi deficiency and yin deficiency with blood stasis，yang deficiency and blood stasis with phlegm-heat，qi deficiency and yin deficiency with phlegm-heat，and yang deficiency and blood stasis with phlegm turbidity than the survival group，and the differences were statistically significant（P＜0.05 or P＜0.01）. Conclusion CHF has the prognosis of developing into yin deficiency or yang deficiency. The death group has higher proportions of qi deficiency and yin deficiency with blood stasis syndrome，and yang deficiency and blood stasis with phlegm turbidity syndrome than the survival group，indicating that there is a poor prognosis，and more attention and early intervention should be done to avoid adverse events.

R259.416

北京市自然科学基金项目（编号：7222294）；首都卫生发展项目（编号：2020-2-4153）；中央高水平临床转化项目（编号：HLCM HPP2023040）