解码儿科功能性咳嗽：区分抽动、心因性和强迫性表型以进行针对性干预。

文献信息

中文摘要

背景： 无明确心肺病理的慢性咳嗽在儿童和青少年中构成诊断和治疗挑战。虽然心理社会因素在其发病机制中起关键作用，但诸如“习惯性咳嗽”或“心因性咳嗽”等历史标签往往模糊且带有污名化。尽管当代共识指南提倡使用“躯体性咳嗽综合征”这一术语，但统一的诊断标准和标准化的诊疗路径仍然缺乏。方法：采用快速综述方法，检索PubMed数据库中2021年至2026年5月发表的关于心理因素相关慢性咳嗽的实证研究，使用的术语包括“心因性咳嗽”、“躯体性咳嗽”、“习惯性咳嗽”、“躯体性咳嗽综合征”和“抽动性咳嗽”。筛选2134条记录后，纳入20篇文章。结果：文献显示慢性咳嗽表现存在显著异质性，并提供了关于心理疾病负担、咳嗽相关感觉和触发因素、抽动样特征以及行为治疗反应的补充证据。大多数研究涉及成人，直接的儿科证据有限。将这些发现与既有的咳嗽指南以及关于抽动、躯体症状和强迫症的相关文献相结合，我们提出了一个基于证据的三分框架，包含三种候选表型：抽动性咳嗽、心因性（躯体性）咳嗽和强迫性咳嗽。该框架强调不同的感觉、情感和认知行为驱动因素及其对多学科管理的意义。结论：基于儿科综合医院的临床现实，本综述为肺科医生等非精神卫生专家提供了一个实用框架，以促进功能性咳嗽中心理行为驱动因素的早期识别。我们呼吁临床范式从被动的“排除性诊断”转向主动的“表型识别”，从而促进真正整合的多学科管理。已知内容：• 无明确心肺病理的慢性咳嗽可能与心理社会因素有关。• 习惯性咳嗽、心因性咳嗽、躯体性咳嗽综合征和抽动性咳嗽等术语使用不一致。新内容：• 我们提出了一个儿科三分框架：抽动性、心因性（躯体性）和强迫性咳嗽。• 该框架将不同的心理行为驱动因素与针对性的多学科管理联系起来。

英文摘要

Chronic cough without clear cardiopulmonary pathology poses diagnostic and therapeutic challenges in children and adolescents. While psychosocial factors play a crucial role in its pathogenesis, historical labels such as "habit cough" or "psychogenic cough" have often been vague and stigmatizing. Despite contemporary consensus guidelines advocating for the term "somatic cough syndrome," unified diagnostic criteria and standardized care pathways remain lacking. A rapid review approach was employed to search the PubMed database for empirical studies published between 2021 and May 2026 on chronic cough related to psychological factors, using terms including "psychogenic cough," "somatic cough," "habit cough," "somatic cough syndrome," and "tic cough." After screening 2134 records, 20 articles were included. The literature showed substantial heterogeneity in chronic cough presentations and provided complementary evidence regarding psychological morbidity, cough-related sensations and triggers, tic-like features, and behavioral treatment response. Most studies involved adults, and direct pediatric evidence was limited. Integrating these findings with established cough guidelines and relevant literature on tic, somatic symptom, and obsessive-compulsive disorders, we propose an evidence-informed tripartite framework comprising three candidate phenotypes: tic cough, psychogenic (somatic) cough, and compulsive cough. The framework emphasizes distinct sensory, affective, and cognitive-behavioral drivers and their implications for multidisciplinary management. Grounded in the clinical realities of pediatric general hospitals, this review provides a practical framework for non-mental health specialists, such as pulmonologists, to facilitate the early identification of psycho-behavioral drivers in functional cough. We call for a clinical paradigm shift from a passive "diagnosis of exclusion" to active "phenotypic identification," thereby promoting truly integrated, multidisciplinary management. What is Known: • Chronic cough without clear cardiopulmonary pathology may be associated with psychosocial factors. • Terms such as habit cough, psychogenic cough, somatic cough syndrome, and tic cough are inconsistently applied. What is New: • We propose a pediatric tripartite framework: tic, psychogenic (somatic), and compulsive cough. • This framework links distinct psycho-behavioral drivers to targeted multidisciplinary management.