目的 探讨冠心病合并焦虑状态（coronary heart disease with anxiety disorder,CHDAD）、冠心病合并抑郁状态（coronary heart disease with depressive disorder,CHDDD）的中医证候、证素分布规律及差异。方法 检索中国知网数据库、万方数据库、维普数据库、中国生物医学文献数据库从建库至2019年7月31日有关CHDAD、CHDDD中医证候分布的流行病学调查研究及中医临床辨证分型治疗研究，收集文献一般资料及病例辨证分型，用Excel 2010建立数据库，统计文献中各中医证侯和病位、病性类证素的频次及频率，运用χ²检验分析CHDAD、CHDDD的证候及证素分布规律及组间差异。结果 共纳入41篇文献，总病例数3357例。CHDAD常见证候类型依次为气滞血瘀证、气郁化火证、肝郁脾虚证、胆经郁热证，CHDDD常见证候类型依次为肝郁气滞证、痰瘀互结证、气滞血瘀证、气虚血瘀证；其中CHDAD肝郁脾虚证、气滞血瘀证明显多于CHDDD，而CHDDD肝郁气滞证、气虚血瘀证显著多于CHDAD（P < 0.001），心血瘀阻在二者分布未见明显差异（P > 0.05）。CHDAD常见病位证素依次是心、肝、脾、胆，CHDDD常见病位证素依次是肝、心、肾、脾；其中CHDAD脾、胆病位证素多于CHDDD，而CHDDD肝、肾、心病位证素多于CHDAD（P < 0.005）。CHDAD常见病性证素依次为气滞、血瘀、火（热）、气虚，CHDDD常见病性证素依次为血瘀、气滞、气虚、痰；其中CHDAD火（热）、气滞病性证素明显多于CHDDD，而CHDDD血瘀、痰、气虚证素多于CHDAD（P < 0.001）。结论 气滞血瘀是冠心病合并焦虑或抑郁状态的核心病机，其中CHDAD气滞偏重，多兼有脾虚，CHDDD血瘀明显，多兼有气虚，故临床治疗应以解郁活血为法，依据兼加证素的不同各随证加减。

Objective To explore TCM syndromes and syndrome elements distribution characteristics and differences between coronary heart disease with anxiety disorder (CHDAD) and coronary heart disease with depressive disorder(CHDDD).Method By searching literatures about epidemiological investigations into TCM syndromes and syndrome elements of coronary heart disease with anxiety or depressive disorders and studies on clinical syndrome differentiation and treatment of TCM in CNKI、Wan fang Data、VIP Data、CBM from the database establishment to July 31, 2019, we collected the general information of the literature and types of syndrome differentiation, then building a database with Excel 2010 software to calculate the frequency and percentage of TCM syndromes and syndrome elements and using chi square test to analyze the distribution characteristics and differences.Result Totally 41 papers and 3357 patients were included, the frequent syndromes of CHDAD were qi stagnation and blood stasis、qi depression transforming into fire、stagnation of liver-qi and spleen deficiency、stagnated heat of gallbladder channel ,the frequent syndromes of CHDDD were stagnation of liver-qi、intermingled phlegm and blood stasis、qi stagnation and blood stasis、qi deficiency and blood stasis; the syndrome distribution of stagnation of liver-qi and spleen deficiency and qi stagnation and blood stasis in CHDAD was exceeding that in CHDDD dramatically, while the syndrome distribution of stagnation of liver-qi and qi deficiency and blood stasis in CHDDD was significantly more than that in CHDAD （P < 0.001）.The distribution of heart blood stasis is more balanced （P > 0.05）.The principal disease location of CHDAD were heart、liver、spleen、gallbladder，and those in CHDDD were liver、heart、kidney、spleen; the element distribution of spleen and gallbladder in CHDAD was more than that in CHDDD, while the distribution of liver、kidney、heart were less than that in CHDDD（P < 0.005）.The prime syndrome elements of CHDAD were qi stagnation、blood stasis、fire、qi deficiency, and in CHDDD were blood stasis、qi stagnation、qi deficiency、phlegm, the element distribution of fire、qi stagnation in CHDAD was more than that in CHDDD, yet the distribution of blood stasis、phlegm and qi deficiency in CHDDD was more than that in CHDAD （P < 0.001）.Conclusions Qi stagnation and blood stasis was the core pathogenesis of coronary heart disease with anxiety or depressive disorder, meanwhile qi stagnation was more salient in CHDAD, and CHDAD involved spleen deficiency frequently; blood stasis was more significant in CHDDD, and CHDDD referred to qi deficiency usually. Therefore, clinical treatment should based on the principle of regulating qi and activating blood circulation, and revise the prescription in accordance with the involving syndrome elements.

国家自然科学基金面上项目（81874410）：益气活血中药优化梗死后纤维化心肌ECM重建策略的效应机制研究；负责人：王承龙。