外阴阴道念珠菌病研究进展：从流行病学、诊断、治疗到耐药机制的综合综述

摘要(中文译文)

外阴阴道假丝酵母菌病（VVC）主要由白假丝酵母菌引起，是育龄期女性最常见的阴道感染之一。由于非白假丝酵母菌感染患病率上升、唑类耐药性不断增加以及生物膜形成的挑战，其临床管理日益复杂。本综述系统总结了VVC研究的最新进展，重点关注流行病学演变、诊断技术创新、当前及新兴治疗手段，并对耐药机制进行深入分析。本文审视了支撑抗真菌耐药的关键分子通路，包括生物膜形成、外排泵过表达、靶位点基因突变以及转录调控因子的改变。本综述的发现支持若干可应用于未来实践的策略。第一，常规使用分子诊断技术（PCR、MALDI-TOF MS）对于菌种鉴定和耐药检测至关重要，可实现从经验性治疗向精准治疗的转变。第二，抗真菌药物敏感性试验的解读应关注阴道pH条件，当确认或怀疑唑类耐药时，应优先考虑非唑类替代药物（硼酸、制霉菌素、ibrexafungerp、oteseconazole）。第三，新兴方法——包括生物膜破坏剂、益生菌微生物组调节和纳米技术增强的药物递送——提供了有前景的辅助和预防策略，尤其对于复发性VVC。通过整合这些当代研究发现，本综述提供了一个转化框架，以优化诊断、指导治疗决策并为VVC管理的未来研究重点提供参考。值得注意的是，包括ibrexafungerp和oteseconazole在内的多种新型药物已获得FDA批准并进入临床实践，同时多项正在进行的试验正在评估硼酸、益生菌和新型口服抗真菌药，凸显了机制导向疗法向患者护理加速转化的趋势。

Abstract

Vulvovaginal candidiasis (VVC), predominantly caused by , is one of the most common vaginal infections in women of reproductive age. Its clinical management has become increasingly complex due to the rising prevalence of non- infections, escalating azole resistance, and the challenge of biofilm formation. This review systematically summarizes recent advances in VVC research, with a focus on evolving epidemiology, innovations in diagnostics, current and emerging therapies, and an in-depth analysis of resistance mechanisms. Key molecular pathways underpinning antifungal resistance-including biofilm development, efflux pump overexpression, target-site gene mutations, and alterations in transcriptional regulators-are examined. The findings of this review support several actionable strategies for future practice. First, routine use of molecular diagnostics (PCR, MALDI-TOF MS) is essential for species identification and resistance detection, enabling a shift from empirical to precision-based therapy. Second, antifungal susceptibility testing should be interpreted with attention to vaginal pH conditions, and non-azole alternatives (boric acid, nystatin, ibrexafungerp, oteseconazole) should be prioritized when azole resistance is confirmed or suspected. Third, emerging approaches-including biofilm-disrupting agents, probiotic microbiome modulation, and nanotechnology-enhanced drug delivery-offer promising adjunctive and preventive strategies, particularly for recurrent VVC. By integrating these contemporary findings, this review provides a translational framework to optimize diagnosis, guide therapeutic decision-making, and inform future research priorities in VVC management. Notably, several novel agents-including ibrexafungerp and oteseconazole-have already received FDA approval and are entering clinical practice, with multiple ongoing trials evaluating boric acid, probiotics, and novel oral antifungals, underscoring the accelerating translation of mechanism-informed therapies into patient care.

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