【目的】 探索慢性胰腺炎（CP）、胰腺导管上皮内瘤变（Pan IN）、胰腺导管腺癌（PDAC）转化过程中的中医证候、证素分 布情况及演变规律。【方法】 回顾性分析与整理 2021年 1月至 2024年 6月山西省中医药研究院收治住院的经病理或临床诊断 为 CP 的患者 330例及 Pan IN 104例、PDAC 276例，共计 710例。应用 EpiData 3.1建立数据库，记录患者一般资料、辅助检 查结果及中医四诊信息。基于因子分析及 K-均值聚类分析，运用 SPSS 27.0 软件对其证候、证素进行判定及统计分析。 【结果】 共得到 CP、Pan IN、PDAC 中医证候类型 7 个。其中 CP 患者的证候分布主要以肝胆湿热证（22.42%）、胃肠实热证 （20.91%）为主，实证证候占比较多（43.33%）；证素分布以热（51.52%）、湿（35.15%）为主；病位在胰腺，与肝、脾胃相关。 Pan IN患者的证候分布主要以脾虚湿阻证（23.08%）、肝胆湿热证（17.31%）为主，虚实夹杂证候占比较多（30.00%）；证素分 布以热（41.35%）、湿（40.38%）、气虚（37.50%）为主；病位在胰腺，与脾、肝相关。PDAC患者的证候分布主要以脾虚湿阻证 （29.71%）、气血亏虚证（20.29%）为主，虚证证候占比较多（49.82%）；证素分布以气虚（50.00%）、湿（36.23%）为主；病位在 胰腺，与脾、肾、肝相关。经过卡方检验后发现，CP癌恶性转化过程中不同阶段证候（中医证候χ2 =100.419，P＜0.001。虚 实证候χ2 =73.722，P＜0.001）、证素（χ2 =117.384，P＜0.001）及病位（χ2 =127.191，P＜0.001）组间均存在显著性差异。在CP癌 恶性转化过程中呈现出实证占比逐渐减少（43.33%→ 12.32%），而虚证占比逐渐增多（26.67%→49.82%）；且实性证素（火、 热、气滞、血瘀）比例逐渐减少（53.48%→25.36%），虚性证素（气虚、阴虚、阳虚、血虚）比例逐渐增加（25.15%→49.64%）； 病位由炎症阶段的以肝、脾胃为主，转变至癌症阶段的以脾、肾为主。【结论】 CP癌恶性转化过程中基本病位在胰腺，前期 与肝、脾胃相关，后期常累及于肾。且随着病程进展，证候、证素演变规律总体表现为“虚实夹杂、由实至虚、脾虚日益 加重”的特点。

Objective To investigate the distribution and evolutionary patterns of traditional Chinese medicine （TCM） syndromes and syndrome elements during the malignant transformation from chronic pancreatitis （CP） to pancreatic intraepithelial neoplasia （Pan IN） and pancreatic ductal adenocarcinoma（PDAC）. Methods A retrospective analysis was conducted on 710 patients （330 of CP， 104 of Pan IN， 276 of PDAC） diagnosed pathologically or clinically at Shanxi Institute of Traditional Chinese Medicine from January 2021 to June 2024. Data including demographics，laboratory results，and TCM diagnostic information were recorded using EpiData 3.1. Syndrome and syndrome-element patterns were determined via factor analysis and K-means clustering using SPSS 27.0. Results The study identifies seven TCM syndrome types in CP， Pan IN， and PDAC. Among CP patients， the syndrome distribution was primarily liver-gallbladder damp-heat syndrome （22.42%） and gastrointestinal excess-heat syndrome （20.91%）， with excess syndromes accounting for a higher proportion （43.33%）； the syndrome elements were mainly heat （51.52%） and dampness （35.15%）， with the disease location in the pancreas，related to the liver，spleen，and stomach. In Pan IN patients，the syndrome distribution was mainly spleen deficiency with dampness obstruction （23.08%） and liver-gallbladder damp-heat syndrome （17.31%），with mixed deficiency-excess syndrome accounting for a higher proportion （30.00%）；the syndrome elements were mainly heat （41.35%）， dampness （40.38%）， and qi deficiency （37.50%）， with the disease location in the pancreas，related to the spleen and liver. In PDAC patients，the syndrome distribution was mainly spleen deficiency with dampness obstruction （29.71%） and qi-blood deficiency syndrome （20.29%）， with deficiency syndromes accounting for a higher proportion （49.82%）； the syndrome elements were mainly qi deficiency （50.00%） and dampness （36.23%），with the disease location in the pancreas，related to the spleen， kidney， and liver. Chi-square tests revealed significant differences in syndrome types （TCM syndromes： χ2 = 100.419，P＜0.001；deficiency-excess syndromes：χ2 =73.722，P＜0.001），syndrome elements （χ2 =117.384， P＜0.001），and disease locations （χ2 =127.191，P＜0.001） across different stages of CP malignant transformation. During CP malignant progression，the proportion of excess syndromes gradually decreased （43.33%→12.32%）， while deficiency syndromes increased （26.67%→49.82%）. Excess syndrome elements （fire，heat，qi stagnation， blood stasis） decreased （53.48%→25.36%），whereas deficiency syndrome elements （qi deficiency，yin deficiency， yang deficiency，blood deficiency） increased （25.15%→49.64%）. The disease location shifted from primarily the liver，spleen，and stomach in the inflammatory stage to the spleen and kidney in the cancerous stage. Conclusion The malignant transformation of CP basically involves the pancreas， is correlated early with liver and spleenstomach and later with kidney，and exhibits a progression from excess to deficiency in the pattern of “deficiency interweaved with excess syndrome，transition from excess to deficiency，and progressive spleen deficiency”.

R273.359

国家中医药管理局第四届国医大师传承工作室项目（编号：国中医药办人教函2022 245号 1123-04）；国家中医药传承创新中心 建设项目（编号：202203）；第二批国家中医临床研究基地建设单位（国中医药科技函 2018 131号）；山西省自然科学基金基础研究面上项目（编号： 202103021224437）