【目的】探讨哮喘-慢性阻塞性肺疾病 （简称慢阻肺） 重叠患者的中医证候学特征、内在规律及中医证素与相关因素的 关系。 【方法】回顾性分析72例哮喘-慢阻肺重叠患者的病历资料，统计中医证素分布，分析不同证素与基础病、检验指标等 因素的相关性。 【结果】（1） 72例哮喘-慢阻肺重叠患者中，涉及的病位证素有肺、心、表、肾、肝、小肠、脾、经络，病性 证素有痰、阴虚、热、气虚、饮、血虚、湿、阳虚、寒、血瘀、外风、气滞、虫积、燥、食积、不固。 （2） 本研究共出现 17 种病位证素组合，其中以两病位证素组合最多，占40.28%（29/72），常见的组合有“肺+表”（18.06%）、“肺+心” （16.67%） 、“肺+心+表” （9.72%） ；共出现55种病性证素组合，其中以虚实夹杂证素组合最多，占58.57% （41/70） ，常见组 合有“痰+热+阴虚” （5.71%） 、“痰+阴虚” （4.29%） 、“痰+热” （4.29%） 、“痰+热+湿+阴虚” （4.29%） 。 （3） Logistics回归分析 结果显示：在哮喘-慢阻肺重叠患者中，肺动脉高压与气虚呈正相关，是气虚 （OR = 1.169） 的独立危险因素 （P＜0.05） ；吸烟 与气虚、心呈正相关，是气虚 （OR = 7.108） 、心 （OR = 29.189） 的独立危险因素 （P＜0.05或P＜0.01） ；糖尿病与表呈正相关， 是表 （OR = 7.091） 的独立危险因素 （P＜0.05） ；血红蛋白与表呈负相关，是表 （OR = 0.969） 的保护因素 （P＜0.05） 。 【结论】哮 喘-慢阻肺重叠的病位在肺，与心、表相关，病性属本虚标实，本虚以阴虚、气虚为主，标实以痰为主，热、饮、湿亦多 见。合并肺动脉高压的患者更易出现气虚证素，有吸烟史的患者更易出现气虚和心的证素，合并糖尿病的患者更易出现表 证素，提高血红蛋白水平可能有助于减少患者表证素的出现。

Objective To explore the TCM syndrome characteristics，inherent patterns，and the relationships between TCM syndrome elements and related factors in patients with asthma-chronic obstructive pulmonary disease （COPD） overlap （ACO） . Methods A retrospective analysis was conducted on the medical records of 72 ACO patients to determine the distribution of TCM syndrome elements and to analyze their correlations with underlying diseases and laboratory indicators. Results （1） Among the 72 ACO patients， the involved diseases-location syndrome elements included lung，heart，exterior，kidney，liver，small intestine，spleen，and meridians， while disease-nature syndrome elements included phlegm，yin deficiency，heat，qi deficiency，fluid retention， blood deficiency，dampness，yang deficiency，cold，blood stasis，external wind，qi stagnation，parasitic infestation，dryness，food stagnation，and instability. （2） The study identified 17 combinations of diseases- location syndrome elements，and the two-element combinations were the most common forms （40.28%，29/72） ，including “lung + exterior” （18.06%）， “lung + heart” （16.67%），and “lung + heart + exterior” （9.72%） . A total of 55 combinations of disease-nature syndrome elements were observed， with mixed deficiency-excess patterns （58.57%，41/70） being predominant. Common combinations included “phlegm + heat + yin deficiency” （5.71%） ， “phlegm + yin deficiency” （4.29%） ， “phlegm + heat” （4.29%） ，and “phlegm + heat + dampness + yin deficiency” （4.29%） . （3） Logistic regression analysis revealed that in ACO patients，pulmonary hypertension was positively correlated with qi deficiency （OR = 1.169，P＜0.05） ，serving as an independent risk factor for qi deficiency. Smoking was positively correlated with qi deficiency （OR = 7.108，P＜0.05） and heart involvement （OR = 29.189， P＜0.01）， acting as their independent risk factors. Diabetes was positively correlated with exterior syndrome （OR = 7.091，P＜0.05） and acted its independent risk factor，while hemoglobin levels were negatively correlated with exterior syndrome （OR = 0.969，P＜0.05） ，acting as a protective factor. Conclusion ACO mainly involves the lung，with associations to the heart and exterior. Its nature is characterized by deficiency in the origin and excess in the superficiality，with yin deficiency and qi deficiency as predominant deficiencies and phlegm as the primary excess， often accompanied by heat， fluid retention， and dampness. Patients with pulmonary hypertension are more prone to qi deficiency，those with a smoking history exhibit higher risks of qi deficiency and heart involvement，diabetic patients are more likely to present exterior syndrome，and the increase of hemoglobin levels may reduce the occurrence of exterior syndrome.

R256.12；R259.63

广东省中医药局科研项目 （编号：20211028）