血脂异常不同危险分层患者的证候分布规律研究*

作者：王彤歆1,2，贾 妍3，鞠建庆1，徐 浩1

单位：1.中国中医科学院西苑医院/国家中医心血管病临床医学研究中心，北京 100091； 2.中国中医科学院研究生院，北京 100700；3.北京中医药大学，北京 100029

引用：引用：王彤歆，贾妍，鞠建庆，徐浩.血脂异常不同危险分层患者的证候分布规律研究[J].中医药导报,2025,31(7):73-78.

DOI：10.13862/j.cn43-1446/r.2025.07.012

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摘要：目的：探讨血脂异常不同危险分层患者的中医证候分布规律，探索血脂异常的核心病机。方法：收集523例血脂异常患者的基本信息、病史及中医四诊信息，进行频数分析、因子分析、聚类分析以及关联规则分析。结果：523例血脂异常患者中湿热质与痰湿质为最常见的体质。最常见的症状依次为乏力、大便黏滞、气短等，最常见的脉象为滑脉、沉脉与数脉，苔质以腻苔为主。因子分析共提取到了7个公因子，可分别归纳为痰湿、湿热、气虚、血瘀等。聚类分析共获得脾虚痰湿、脾胃湿热、阴阳两虚、血瘀等4个证候。关联分析结果显示，低危患者与火热、湿、痰、气滞、气虚等证素关系密切，中危患者与痰、火热、湿、气虚等证素关系密切，高危患者与血瘀、痰、阴虚、阳虚、湿、气虚等证素关系密切。结论：痰湿是血脂异常的核心病机，在低危及中危患者中会随体质特点热化、实化而为脾胃湿热，或寒化、虚化而成脾虚痰湿，在高危患者中则多见痰瘀互结，或合并阴虚及阳虚。

关键词：血脂异常；证候分布；核心病机；痰湿；因子分析；聚类分析

Abstract：

Objective: To investigate the distribution patterns of traditional Chinese medicine (TCM) syndromes in patients with dyslipidemia at different risk stratifications and explore the core pathogenesis of dyslipidemia. Methods: A total of 523 patients with dyslipidemia were enrolled, and their demographic data, medical history, and TCM four-diagnostic information (inspection, auscultation/olfaction, inquiry, and palpation) were collected. Frequency analysis, factor analysis, cluster analysis, and association rule analysis were performed. Results: Among the 523 patients, damp-heat constitution and phlegm-dampness constitution were the most common TCM constitutions. The most frequent symptoms included fatigue, sticky stools, and shortness of breath. The predominant pulse manifestations were slippery pulse, deep pulse, and rapid pulse, while the tongue coating primarily exhibited a greasy texture. Factor analysis extracted seven common factors, categorized as phlegm-dampness, damp-heat, qi deficiency, and blood stasis. Cluster analysis identified four syndrome patterns: spleen deficiency with phlegm-dampness, damp-heat in the spleen and stomach, yin-yang deficiency, and blood stasis. Association rule analysis revealed that low-risk patients were closely associated with syndrome elements such as fire-heat, dampness, phlegm, qi stagnation, and qi deficiency; moderate-risk patients with phlegm, fire-heat, dampness, and qi deficiency; and high-risk patients with blood stasis, phlegm, yin deficiency, yang deficiency, dampness, and qi deficiency. Conclusion: Phlegm-dampness constitutes the core pathogenesis of dyslipidemia. In low- and moderate-risk patients, it may transform into damp-heat in the spleen and stomach (due to heat or excess tendencies) or spleen deficiency with phlegm-dampness (due to cold or deficiency tendencies). In high-risk patients, phlegm-blood stasis intermingling or concurrent yin deficiency and yang deficiency are predominant.

Key words：stratifications; distribution patterns; core pathogenesis; phlegm-dampness; factor analysis; cluster analysis

发布时间：2026-01-06

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