diff --git a/crates/erp-server/tests/integration/health_appointment_tests.rs b/crates/erp-server/tests/integration/health_appointment_tests.rs
index de19b11..5802f05 100644
--- a/crates/erp-server/tests/integration/health_appointment_tests.rs
+++ b/crates/erp-server/tests/integration/health_appointment_tests.rs
@@ -5,7 +5,7 @@
 //! 预约创建依赖患者 + 医护档案 + 排班三条前置数据。
 
 use erp_core::events::EventBus;
-use erp_health::dto::appointment_dto::CreateAppointmentReq;
+use erp_health::dto::appointment_dto::{CreateAppointmentReq, UpdateAppointmentStatusReq};
 use erp_health::dto::doctor_dto::CreateDoctorReq;
 use erp_health::dto::patient_dto::CreatePatientReq;
 use erp_health::service::{
@@ -246,3 +246,149 @@ async fn test_appointment_tenant_isolation() {
         "跨租户查询预约应返回错误"
     );
 }
+
+// ---------------------------------------------------------------------------
+// 测试 4: 预约状态流转 — pending → confirmed → completed
+// ---------------------------------------------------------------------------
+
+#[tokio::test]
+async fn test_appointment_status_flow() {
+    let test_db = TestDb::new().await;
+    let state = make_state(test_db.db());
+    let tenant_id = uuid::Uuid::new_v4();
+    let operator_id = uuid::Uuid::new_v4();
+
+    let patient_id = seed_patient(&state, tenant_id, "状态患者").await;
+    let doctor_id = seed_doctor(&state, tenant_id, "状态医生").await;
+    let date = chrono::NaiveDate::from_ymd_opt(2026, 5, 15).unwrap();
+    seed_schedule(&state, tenant_id, doctor_id, date).await;
+
+    let appt = appointment_service::create_appointment(
+        &state, tenant_id, Some(operator_id),
+        CreateAppointmentReq {
+            patient_id,
+            doctor_id: Some(doctor_id),
+            appointment_type: None,
+            appointment_date: date,
+            start_time: chrono::NaiveTime::from_hms_opt(9, 0, 0).unwrap(),
+            end_time: chrono::NaiveTime::from_hms_opt(9, 30, 0).unwrap(),
+            notes: None,
+        },
+    )
+    .await
+    .expect("创建预约应成功");
+    assert_eq!(appt.status, "pending");
+
+    // pending → confirmed
+    let confirmed = appointment_service::update_appointment_status(
+        &state, tenant_id, appt.id, Some(operator_id),
+        UpdateAppointmentStatusReq { status: "confirmed".to_string(), cancel_reason: None },
+        appt.version,
+    )
+    .await
+    .expect("确认应成功");
+    assert_eq!(confirmed.status, "confirmed");
+
+    // confirmed → completed
+    let completed = appointment_service::update_appointment_status(
+        &state, tenant_id, appt.id, Some(operator_id),
+        UpdateAppointmentStatusReq { status: "completed".to_string(), cancel_reason: None },
+        confirmed.version,
+    )
+    .await
+    .expect("完成应成功");
+    assert_eq!(completed.status, "completed");
+}
+
+// ---------------------------------------------------------------------------
+// 测试 5: 预约取消 — pending → cancelled
+// ---------------------------------------------------------------------------
+
+#[tokio::test]
+async fn test_appointment_cancel() {
+    let test_db = TestDb::new().await;
+    let state = make_state(test_db.db());
+    let tenant_id = uuid::Uuid::new_v4();
+
+    let patient_id = seed_patient(&state, tenant_id, "取消患者").await;
+    let doctor_id = seed_doctor(&state, tenant_id, "取消医生").await;
+    let date = chrono::NaiveDate::from_ymd_opt(2026, 5, 16).unwrap();
+    seed_schedule(&state, tenant_id, doctor_id, date).await;
+
+    let appt = appointment_service::create_appointment(
+        &state, tenant_id, None,
+        CreateAppointmentReq {
+            patient_id,
+            doctor_id: Some(doctor_id),
+            appointment_type: None,
+            appointment_date: date,
+            start_time: chrono::NaiveTime::from_hms_opt(9, 0, 0).unwrap(),
+            end_time: chrono::NaiveTime::from_hms_opt(9, 30, 0).unwrap(),
+            notes: None,
+        },
+    )
+    .await
+    .expect("创建应成功");
+
+    let cancelled = appointment_service::update_appointment_status(
+        &state, tenant_id, appt.id, None,
+        UpdateAppointmentStatusReq {
+            status: "cancelled".to_string(),
+            cancel_reason: Some("患者临时有事".to_string()),
+        },
+        appt.version,
+    )
+    .await
+    .expect("取消应成功");
+    assert_eq!(cancelled.status, "cancelled");
+}
+
+// ---------------------------------------------------------------------------
+// 测试 6: 预约乐观锁 — 旧版本更新拒绝
+// ---------------------------------------------------------------------------
+
+#[tokio::test]
+async fn test_appointment_version_conflict() {
+    let test_db = TestDb::new().await;
+    let state = make_state(test_db.db());
+    let tenant_id = uuid::Uuid::new_v4();
+    let operator_id = uuid::Uuid::new_v4();
+
+    let patient_id = seed_patient(&state, tenant_id, "乐观锁患者").await;
+    let doctor_id = seed_doctor(&state, tenant_id, "乐观锁医生").await;
+    let date = chrono::NaiveDate::from_ymd_opt(2026, 5, 17).unwrap();
+    seed_schedule(&state, tenant_id, doctor_id, date).await;
+
+    let appt = appointment_service::create_appointment(
+        &state, tenant_id, Some(operator_id),
+        CreateAppointmentReq {
+            patient_id,
+            doctor_id: Some(doctor_id),
+            appointment_type: None,
+            appointment_date: date,
+            start_time: chrono::NaiveTime::from_hms_opt(9, 0, 0).unwrap(),
+            end_time: chrono::NaiveTime::from_hms_opt(9, 30, 0).unwrap(),
+            notes: None,
+        },
+    )
+    .await
+    .expect("创建应成功");
+
+    // 正确版本确认
+    let _confirmed = appointment_service::update_appointment_status(
+        &state, tenant_id, appt.id, Some(operator_id),
+        UpdateAppointmentStatusReq { status: "confirmed".to_string(), cancel_reason: None },
+        appt.version,
+    )
+    .await
+    .expect("确认应成功");
+
+    // 用旧版本再更新应失败
+    let result = appointment_service::update_appointment_status(
+        &state, tenant_id, appt.id, Some(operator_id),
+        UpdateAppointmentStatusReq { status: "cancelled".to_string(), cancel_reason: None },
+        appt.version, // 旧版本
+    )
+    .await;
+    assert!(result.is_err(), "旧版本更新应失败");
+}