Abstract: Background　Bronchial asthma is a common disease of respiratory system，and positive results of bronchial provocation or dilation test are important evidence in the diagnosis of bronchial asthma.However，suspected positive bronchial provocation or dilation test results associated with symptoms are often observed in clinical practice.At present，there is no literature report on analyzing the influencing factors of the prognosis outcome of such patients.Objective　To investigate the prognostic outcomes of patients with suspected positive results in bronchial provocation or dilation test and its influencing factors.Methods　From August 2015 to February 2018，320 patients with suspected positive results in bronchial provocation or dilation test accompanied by at least one symptom of cough，expectoration，itching throat，wheezing，dyspnea and chest tightness were followed up for six months.The pulmonary function was reviewed and the symptoms and TCM syndrome scores were recorded to analyze the outcomes of the patients.Significant difference of clinical symptom proportion and TCM syndrome scores before and after follow-up was considered to be the remission of the disease.A transfer from suspected positive results to negative results in bronchial provocation or dilation test after six months was considered to be the improvement of the disease.Factors influencing the outcome of suspected positive patients with bronchial provocation or dilation test were analyzed by Logistic regression analysis.Results　A total of 146 patients completed the 6-month follow-up，of which 49 patients were tested with suspected positive results in bronchial provocation test and 97 patients were tested with suspected positive results in bronchial dilation test.Among those 49 cases with suspected positive results in bronchial provocation test，20（40.8%） patients were tested with negative results；2（4.1%） patients were tested with positive results；4（8.2%） patients remained the same results，and 23（46.9%） patients underwent bronchial dilation test after six months.Among those 97 cases with suspected positive results in bronchial dilation test，44（45.4%） patients were tested with negative results；4（4.1%） patients were tested with positive results；10（10.3%） patients remained the same results，and 39（40.2%） patients underwent bronchial provocation test after six months.After 6-month of follow-up，the patients' TCM syndrome scores decreased（P<0.05）.Among the patients enrolled，major symptoms（cough，expectoration，itching throat，wheezing，dyspnea，and chest tightness） were relieved with significant difference after six months（P<0.05）.Analysis which was carried out on 84 patients who used bronchial provocation or dilation test before and 6 months after the follow-up showed that，there was a significant difference in the outcome of suspected positive patients in different age groups（P<0.05），and the improvement rates of pulmonary function were higher in patients applying acupoint application of traditional Chinese medicine or without allergic rhinitis and inhaled glucocorticoid（P<0.05）.The Logistic regression analysis results showed that under the condition of multiple factors acting at the same time，there was no significant factor affecting the prognosis of patients suspected to be positive in bronchial provocation or dilation test.Conclusion　Most patients with suspected positive results in bronchial provocation or dilatation test have reversible airway inflammatory responses.Patients may benefit from acupoint application of Chinese traditional medicine.

Key words: Bronchial provocation tests, Bronchial dilation tests, Suspicious positive results, Pulmonary function, Prognosis, Root cause analysis

摘要： 背景　支气管哮喘是呼吸系统常见病，支气管激发或舒张试验阳性为诊断支气管哮喘的重要依据，但临床上常见支气管激发或舒张试验可疑阳性，且伴有临床症状的患者。目前尚缺乏分析此类患者预后转归结局的文献报道。目的　探讨支气管激发或舒张试验可疑阳性患者预后转归及其影响因素。方法　2015年8月—2018年2月，对320例支气管激发或舒张试验可疑阳性，并伴有咳嗽、咳痰、咽痒、喘息、气促、胸闷症状至少1项的患者，进行为期6个月随访，复查肺功能并记录症状、中医证候积分，统计患者的转归情况。随访前后临床症状占比、中医证候积分差异有统计学意义视为缓解，6个月后支气管激发或舒张试验可疑阳性转阴性视为好转。采用Logistic回归分析影响支气管激发或舒张试验可疑阳性患者转归的因素。结果　146例患者完成6个月的随访研究，其中49例支气管激发试验可疑阳性，97例支气管舒张试验可疑阳性。支气管激发试验可疑阳性6个月后转阴性者20例（40.8%），转阳性者2例（4.1%），可疑阳性者4例（8.2%），转支气管舒张试验者23例（46.9%）；支气管舒张试验可疑阳性6个月后转阴性者44例（45.4%），转阳性者4例（4.1%），可疑阳性者10例（10.3%），转支气管激发试验者39例（40.2%）。随访6个月后，患者的中医证候积分降低（P<0.05）。患者主要症状（咳嗽、咳痰、咽痒、喘息、气促、胸闷）在6个月后都得到缓解，差异有统计学意义（P<0.05）。将随访前与随访6个月后均进行支气管激发试验或均进行支气管舒张试验的84例患者纳入分析，结果显示，不同年龄支气管激发或舒张试验可疑阳性患者转归比较，差异有统计学意义（P<0.05）；中药穴位贴敷治疗、无过敏性鼻炎、未使用吸入性糖皮质激素的患者，肺功能好转率更高（P<0.05）。Logistic回归分析结果显示，在多个因素同时作用的情况下，并无明显影响支气管激发或舒张试验可疑阳性患者预后转归的因素。结论　支气管激发或舒张试验可疑阳性患者的气道炎性反应大多处于可逆状态，中药穴位贴敷可能使患者获益。

关键词: 支气管激发试验, 支气管舒张试验, 可疑阳性, 肺功能, 预后, 影响因素分析