目的 分析慢性阻塞性肺疾病（COPD）致肺动脉高压患者中医证型分布及超声心动图特征。方法 回顾性分析我院2024年7月—2025年6月收治的287例COPD患者的病历资料,根据是否合并肺动脉高压将患者分为两组,其中COPD致肺动脉高压患者纳入A组（172例）,单纯COPD患者纳入B组（115例）。观察A组患者按中医证候分型,比较两组患者超声心动图相关参数指标[右室心底舒张末横径（RV-bDD）、右室中部舒张末横径（RV-mDD）、右室游离壁舒张末期厚度（RVDT）、右室收缩末期容积（RVESA）、右室舒张末期容积（RVEDA）、三尖瓣环收缩期位移（TAPSE）、右室面积变化分数（FAC）、右室心肌做功指数（RIMP）、主肺动脉内径（MPA）、三尖瓣反流峰值流速（TRV）、右心室收缩压（RVSP）],采用Logistic多因素分析COPD致肺动脉高压的影响因素,绘制受试者工作（ROC）曲线分析超声心动图指标对不同中医证型COPD致肺动脉高压患者的诊断价值。结果 172例COPD致肺动脉高压患者中气虚血瘀证54例（31.40%）、痰瘀阻肺证42例（24.42%）、痰浊阻肺证32例（18.60%）、肺肾气阴两虚证21例（12.21%）、痰热壅肺证16例（9.30%）、脾肺气虚证7例（4.07%）。A组相较B组在MPA、TRV、RVSP、RV-bDD、RV-mDD、RVDT、RVESA、RVEDA、RIMP上更高,在TAPSE、FAC上更低。经Logistic多因素分析,超声心动图指标中MPA、TRV、RVSP、RV-bDD、RV-mDD、RVDT、RVESA、RVEDA、RIMP水平是COPD致肺动脉高压的危险因素,TAPSE、FAC水平是COPD致肺动脉高压的保护因素。COPD致肺动脉高压患者中痰浊阻肺证患者相较于气虚血瘀证患者在TRV和RVSP上明显更低;其他证型相较气虚血瘀证患者在TRV和RVSP上比较无明显差异。绘制ROC曲线分析可知,TRV和RVSP对COPD致肺动脉高压患者中气虚血瘀证诊断的ROC曲线下面积（AUC）分别为0.627、0.686。结论 COPD致肺动脉高压患者中气虚血瘀证者占比最高,脾肺气虚证者占比最低,患者右室功能明显下降,超声心动图可无创、准确评估患者右心功能,超声心动图相关参数指标可提示并发肺动脉高压的风险,且对气虚血瘀证和痰浊阻肺证这两种中医证候分型具有一定的诊断价值。

Objective To analyze the traditional Chineses medicine (TCM) syndrome distribution and echocardiographic characteristics of patients with pulmonary hypertension caused by chronic obstructive pulmonary disease (COPD). Methods A retrospective analysis was performed on the case data of 287 patients with COPD admitted to the hospital from July 2024 to June 2025. Patients were grouped according to whether they had pulmonary hypertension.172 patients with pulmonary hypertension caused by COPD were included in group A, and 115 patients with simple COPD were set as group B. The TCM syndrome types of patients in group A were observed, and the related echocardiographic parameters [right ventricular end-diastolic diameter (RV-bDD), right ventricular middle end-diastolic diameter (RV-mDD), right ventricular free end-diastolic thickness (RVDT), right ventricular end-systolic area (RVESA), right ventricular end-diastolic area (RVEDA), tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (FAC), right ventricular myocardial performance index (RIMP) main pulmonary artery diameter (MPA), tricuspid regurgitation peak velocity (TRV), right ventricular systolic pressure (RVSP)] were compared between the two groups of patients. Logistic multivariate analysis was used to analyze the influencing factors of pulmonary hypertension caused by COPD, and receiver operating characteristic (ROC) curve was drawn to analyze the diagnostic value of echocardiographic indicators in patients with pulmonary hypertension caused by COPD with different TCM syndromes types. Results Among the 172 patients with pulmonary hypertension caused by COPD, there were 54 cases (31.40%) of qi deficiency and blood stasis syndrome, 42 cases (24.42%) of phlegm and blood stasis obstructing lung syndrome, 32 cases (18.60%) of phlegm turbidity obstructing lung syndrome, 21 cases (12.21%) of lung-kidney qi deficiency syndrome, 16 cases (9.30%) of phlegm-heat obstructing lung syndrome and 7 cases (4.07%) of spleen-lung qi deficiency syndrome. Compared with group B, group A had higher MPA, TRV, RVSP, RV-bDD, RV-mDD, RVDT, RVESA, RVEDA and RIMP and lower TAPSE and FAC. Logistic multivariate analysis showed that high levels of echocardiographic indicators such as MPA, TRV, RVSP, RV-bDD, RV-mDD, RVDT, RVESA, RVEDA and RIMP were risk factors of pulmonary hypertension caused by COPD, and high levels of TAPSE and FAC were protective factors of pulmonary hypertension caused by COPD. Among patients with pulmonary hypertension caused by COPD, patients with phlegm and blood stasis obstructing lung syndrome showed significantly lower TRV and RVSP than patients with qi deficiency and blood stasis syndrome. There were no significant differences in TRV and RVSP between patients with other syndromes and patients with qi deficiency and blood stasis syndrome. ROC curve analysis showed that the areas under the ROC curves (AUC) of TRV and RVSP in the diagnosis of qi deficiency and phlegm turbidity obstructing lung syndrome. in patients with pulmonary hypertension caused by COPD were 0.627 and 0.686 respectively. Conclusion Among the patients with pulmonary hypertension caused by COPD, the proportion of qi deficiency and blood stasis syndrome is the highest, and the proportion of spleen-lung qi deficiency syndrome is the lowest, and the right ventricular function of patients is significantly decreased. Echocardiography can noninvasively and accurately evaluate the right ventricular function in patients. The related parameters of echocardiography can indicate the risk of pulmonary hypertension, and have certain diagnostic value for the two TCM syndromes types of qi deficiency and blood stasis syndrome and phlegm turbidity obstructing lung syndrome.