【目的】 探索中老年干眼症患者的中医证素及证型分布情况，为该病的临床治疗提供循证医学依据。【方法】 回顾性分 析2024年3月至2024年10月安徽中医药大学附属六安市中医院眼科收治的279例中老年干眼症患者临床资料，记录患者一 般资料及中医四诊信息，建立数据库，结合临床经验，以出现频率≥20% 的 39个四诊信息作为因子分析变量，选取出特征 值＞1的公因子11个，进行聚类分析。【结果】（1）一般资料：性别分布方面，279例干眼症患者中，男性82例（占 29.39%）， 女性 197 例（占 70.61%）；年龄分布方面，45～59 岁患者 116 例（占 41.58%），60～74 岁患者 89 例（占 31.90%），75～89岁 患者 74 例（占 26.52%），其发病率随着年龄的增加而呈递减趋势。（2）因子分析方面：共提取 11 个公因子，累计贡献率 73.676%；病位证素包括肝、肾、脾、表、大肠、心神，主要病位为肝、肾；病性证素包括阴虚、热、气虚、阳亢、湿、血 瘀、外风，主要病性为阴虚。（3）聚类分析方面：聚为 4类时，证型分布最合理。第一类包含公因子 F4、F5、F6，为气阴两 虚证（52例，18.64%）；第二类包含公因子F2、F7、F8、F9，为肝肾阴虚阳亢证（96例，34.41%）；第三类包含公因子F1，为 湿热瘀阻证（85例，30.47%）；第四类包含公因子 F3、F10，为邪热留恋证（46例，16.49%）。【结论】 中老年干眼症患者病位 复杂，病性多样，具体证型包括肝肾阴虚阳亢证、湿热瘀阻证、气阴两虚证、邪热留恋证。

Objective To explore the distribution of traditional Chinese medicine （TCM） syndrome elements and syndrome types in middle-aged and elderly patients with dry eye disease，thereby providing a syndrome-based medical foundation for its clinical treatment. Methods A retrospective analysis was conducted on the clinical data of 279 middle-aged and elderly patients with dry eye disease enrolled in the Ophthalmology Department of Lu’an Hospital of Traditional Chinese Medicine Affiliated to Anhui University of Chinese Medicine between March 2024 and October 2024. Patient general information and TCM four-examination information were recorded to establish a database. Based on clinical experience， 39 four-examination signs with a frequency of occurrence ≥20% were selected as variables for factor analysis. Eleven common factors with eigenvalues ＞1 were extracted and subsequently subjected to cluster analysis. Results （1）General patient information：Regarding gender distribution， among the 279 dry eye patients， 82 were male （29.39%） and 197 were female （70.61%）. Regarding age distribution，116 patients （41.58%） were aged 45-59 years，89 patients （31.90%） were aged 60-74 years，and 74 patients （26.52%） were aged 75-89 years，the prevalence showing a decreasing trend with the increase of age. （2） Factor analysis：Eleven common factors were extracted，with a cumulative contribution rate of 73.676%. The disease location syndrome elements included liver，kidney，spleen，exterior，large intestine，and heart spirit， with the primary locations being the liver and kidney. The disease nature syndrome elements included yin deficiency， heat， qi deficiency， yang hyperactivity， dampness， blood stasis， and external wind， with the primary nature being yin deficiency. （3） Cluster analysis： The distribution of syndrome types was most reasonable when clustered into 4 categories. Category 1， comprising common factors F4， F5， and F6， corresponded to qi and yin deficiency syndrome （52 cases，18.64%）. Category 2，comprising common factors F2， F7， F8， and F9， corresponded to liver-kidney yin deficiency with yang hyperactivity syndrome （96 cases， 34.41%）. Category 3， comprising common factor F1， corresponded to damp-heat and blood stasis obstruction syndrome （85 cases， 30.47%）. Category 4， comprising common factors F3 and F10， corresponded to lingering pathogenic heat syndrome （46 cases，16.49%）. Conclusion Middle-aged and elderly patients with dry eye disease present with complex disease locations and diverse disease natures. The specific syndrome types include liver-kidney yin deficiency with yang hyperactivity， obstruction of damp-heat and blood stasis， deficiency of both qi and yin，and lingering pathogenic heat.

R276.7

安徽省科技厅科研基金项目（编号：2024AH050550）；安徽中医药大学科研基金项目（编号：2024LC021）