关键词: 支气管激发试验, 基础肺功能, 乙酰甲胆碱, 医院科室, 疾病特征

Abstract: Background　The bronchial provocation test（BPT）is a widely utilized method for assessing airway hyperreactivity（AHR）and serves as a crucial tool for both the diagnosis and therapeutic evaluation of asthma. Despite its significance，BPT is often underutilized outside the field of respiratory medicine. Objective　This study aims to analyze the application of BPT across various hospital departments，as well as the BPT positive rate and AHR severity grades，using real-world data from a large sample of BPT cases. Methods　BPT reports from the First Affiliated Hospital of Guangzhou Medical University，spanning March 2017 to April 2022，were systematically collected for analysis. Reports pertaining to children（under 18 years of age）and those lacking critical indicators were excluded from the study. The analysis focused on the distribution of BPT applications across various departments，the rate of positive BPT results，and the classification of clinical diagnoses. Positive BPT data were categorized into two groups：those positive prior to methacholine inhalation and those positive post-inhalation. The former group was designated as the "very severe" category，while the latter was further subdivided into "very mild" "mild， " "moderate" and "severe" categories based on PD20 values. Comparative analyses of age，height，weight，and baseline lung function indices were conducted across these groups. Additionally，multivariate Logistic regression analysis was employed to identify risk factors associated with positive BPT outcomes. Results　In this study，a total of 24 034 BPT reports were analyzed. The distribution of report outcomes was as follows：27.91% were positive，67.83% were negative，and 4.22% were suspected positive. Additionally，8 cases did not complete the test. The internal and surgical BPT reports constituted 86.50% and 3.07% of the total，respectively，with corresponding positive rates of 28.30% and 18.70%. The study included only 2 gynecological patients，of whom 1 tested positive. Significant differences were observed in age，body weight，forced expiratory volume in the first second（FEV1），percentage of predicted FEV1（FEV1%pred），forced vital capacity（FVC），FEV1/FVC ratio， and percentage of predicted FEV1/FVC（FEV1/FVC%pred）among the BPT positive groups（all P< 0.05）. Notably，FEV1， FEV1%pred，FEV1/FVC，and FEV1/FVC%pred values decreased progressively with increasing severity of AHR（P< 0.05）. Multivariate Logistic regression analysis identified several risk factors for positive BPT results，including age over 40 years， female gender，body mass index（BMI）≥ 24，clinical diagnosis of asthma，FEV1%pred < 80%，and FEV1/FVC%pred < 92%（P< 0.05）. A total of 51 adverse events associated with BPT were recorded，all of which were classified as very mild or mild. Among these，8 cases were unable to complete the test due to intolerance. Conclusion　BPT remains the gold standard for the rapid clinical diagnosis of AHR，offering significant value for clinical guidance. The positive rate of BPT in patients with suspected AHR is high not only in the respiratory department but also among other medical departments，warranting increased attention to BPT. Particular vigilance is advised for patients with low baseline FEV1 and FEV1/FVC，especially in females， people over 40 years old or with a high BMI. BPT is generally considered safe，but it is crucial to closely monitor changes in FEV1 and any adverse reactions during provocation tests.

Key words: Bronchial provocation tests, Basic lung function, Methacholine, Hospital departments, Disease attributes