【目的】 研究慢性心力衰竭（CHF）合并肾功能不全（CKD）患者的中医证型分布规律，并探讨其中医证型与理化指标及 预后之间的关联性。【方法】 收集2006年1月至2014年3月期间在中国中医科学院广安门医院心内科住院治疗的217例CHF合 并CKD患者的四诊资料，确定中医证型，采集患者的一般资料及理化指标，运用SPSS 26.0统计软件分析CHF合并CKD患者 的中医证型分布特点及其与一般资料、理化指标和预后的关系。【结果】（1）217 例 CHF 合并 CKD 患者中，男性 114 例，女 性 103 例，男女比例为 1.11∶1，发病率相近。（2）中医证型分布从高到低依次为阳虚痰瘀证（占 23.04%）、阴虚痰瘀证（占 22.12%）、血瘀痰浊证（占21.20%）、气阴两虚证（占17.51%）和气虚血瘀证（占16.13%）。（3）年龄方面，血瘀痰浊证组患者的 年龄最小，气阴两虚证组和阴虚痰瘀证组患者的年龄较大，血瘀痰浊证组与气阴两虚证组和阴虚痰瘀证组比较，差异均有 统计学意义（P＜0.05）；病程方面，血瘀痰浊证组的病程短于阳虚痰瘀证组，差异有统计学意义（P＜0.01）；死亡率方面，血 瘀痰浊证组的死亡率小于气阴两虚证组、阴虚痰瘀证组及阳虚痰瘀证组，差异均有统计学意义（P＜0.01）。（4）气阴两虚证组 的 N 末端脑钠肽前体（NT-proBNP）水平高于血瘀痰浊证组，阴虚痰瘀证组、阳虚痰瘀证组及气阴两虚证组的肾小球滤过率 （eGFR-EPI）水平高于血瘀痰浊证组，阴虚痰瘀证组及阳虚痰瘀证组的极低密度脂蛋白（VLDL）水平高于气阴两虚证组，气阴 两虚证组的血氯（Cl- ）水平低于阴虚痰瘀证组，差异均有统计学意义（P＜0.05或P＜0.01）。此外，不同证型间的性别、死亡 时间、血小板（PLT）、白细胞计数（WBC）、红细胞计数（RBC）、血红蛋白（Hb）、C反应蛋白（CRP）、尿酸（UA）、血钾（K+ ）、 血钠（Na+ ）、甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、空腹血糖 （FPG）、丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、血清总胆红素（TBIL）、直接胆红素（DBIL）、间接胆红素 （IBIL）、心脏射血分数（EF）、左室短轴缩短率（FS）、血肌酐（Scr）、尿素氮（BUN）及美国纽约心脏病协会（NYHA）心功能分 级比较，差异均无统计学意义（P＞0.05）。【结论】 临床判断CHF合并CKD患者病情时，应抓住虚实转归这一关键点，同时注 重本虚的干预，尽量延缓患者病情进展，拉长病情由实转虚的时间线，延长生存期。此外，痰瘀胶结是CHF合并CKD患者 的核心病机，基于“脾为生痰之源”，对于虚实夹杂证的干预，在祛邪的同时，应兼顾脾气的固护，同时兼顾血瘀、气虚等 兼夹症候，釜底抽薪，杜绝痰饮内生之源，又给之以外达的通路，辨明病因病机，针对性治疗。

Objective To investigate the distribution patterns of traditional Chinese medicine （TCM） syndrome types in patients with chronic heart failure （CHF） complicated with chronic kidney disease （CKD），and to explore the correlation between TCM syndrome types and physicochemical indicators as well as the prognosis. Methods A total of 217 patients with CHF and CKD hospitalized in the Department of Cardiology，Guang’anmen Hospital， China Academy of Chinese Medical Sciences between January 2006 and March 2014 were included. Data from the four-examination methods of TCM were collected to determine TCM syndrome types. General information and physicochemical indicators of the patients were also recorded. SPSS 26.0 statistical software was used to analyze the distribution characteristics of TCM syndrome types and their relationships with general information， physicochemical indicators，and the prognosis. Results （1） Among the 217 patients，114 were male and 103 were female，with a male-to-female ratio of 1.11∶1，indicating similar incidence between genders.（2） The distribution of TCM syndrome types in descending order was as follows： yang deficiency with phlegm-stasis syndrome （23.04%），yin deficiency with phlegm-stasis syndrome （22.12%），blood stasis and phlegm turbidity syndrome （21.20%），qi and yin deficiency syndrome （17.51%），and qi deficiency with blood stasis syndrome （16.13%）. （3） Regarding age，the blood stasis and phlegm turbidity syndrome group was the youngest，while the qi and yin deficiency syndrome group and the yin deficiency with phlegm-stasis syndrome group were relatively old. The differences between the blood stasis and phlegm turbidity syndrome group and the other two groups were statistically significant （P＜0.05）. In terms of disease duration，the blood stasis and phlegm turbidity syndrome group had a shorter course than the yang deficiency with phlegm-stasis syndrome group， with a statistically significant difference （P＜0.01）. Regarding mortality， the blood stasis and phlegm turbidity syndrome group had a lower mortality rate compared to the qi and yin deficiency syndrome，yin deficiency with phlegm-stasis syndrome，and yang deficiency with phlegm-stasis syndrome groups，with statistically significant differences （P＜0.01）.（4） The N-terminal pro-brain natriuretic peptide （NT-proBNP） level in the qi and yin deficiency syndrome group was higher than that in the blood stasis and phlegm turbidity syndrome group. The estimated glomerular filtration rate （eGFR-EPI） level in the yin deficiency with phlegm-stasis syndrome， yang deficiency with phlegm-stasis syndrome，and qi and yin deficiency syndrome groups was higher than that in the blood stasis and phlegm turbidity syndrome group. The very low-density lipoprotein （VLDL） level in the yin deficiency with phlegm-stasis syndrome and yang deficiency with phlegm-stasis syndrome groups was higher than that in the qi and yin deficiency syndrome group. The blood chloride （Cl- ） level in the qi and yin deficiency syndrome group was lower than that in the yin deficiency with phlegm-stasis syndrome group. All these differences were statistically significant （P＜0.05 or P＜ 0.01）. Additionally，no statistically significant differences were observed among different syndrome types in terms of gender，time of death，platelet count （PLT），white blood cell count （WBC），red blood cell count （RBC）， hemoglobin （Hb），C-reactive protein （CRP），uric acid （UA），blood potassium （K+ ），blood sodium （Na+ ）， triglycerides （TG）， total cholesterol （TC）， high-density lipoprotein cholesterol （HDL-C）， low-density lipoprotein cholesterol （LDL-C），fasting plasma glucose （FPG），alanine aminotransferase （ALT），aspartate aminotransferase （AST），total bilirubin （TBIL），direct bilirubin （DBIL），indirect bilirubin （IBIL），ejection fraction （EF），fractional shortening （FS），serum creatinine （Scr），blood urea nitrogen （BUN），and New York Heart Association （NYHA） functional classification （P＞0.05）. Conclusion In clinical assessment of patients with CHF and CKD， it is essential to focus on the transition between deficiency and excess syndromes and to emphasize the intervention for the underlying deficiency. Efforts should be made to delay disease progression， prolong the timeline of transformation from excess to deficiency，and extend survival. Furthermore，the phlegmstasis concretion is the core pathogenesis in these patients. Based on the TCM theory of the spleen being the source of phlegm production，interventions for mixed deficiency-excess syndromes should not only eliminate pathogenic factors but also reinforce spleen qi. Concurrently， attention should be paid to accompanying symptoms such as blood stasis and qi deficiency. By addressing the root cause and cutting off the source of internal phlegm formation while ensuring pathways for its elimination，targeted treatment can be achieved through clarifying the etiology and pathogenesis.

R259.416

首都卫生发展科研专项资助项目（编号：2022-2-4153）；北京市自然科学基金项目（编号：7222294）；中国中医科学院科技创新 工程项目（编号：HLCMHPP2023040）