临床指南
ENGLISH ABSTRACT
外阴阴道假丝酵母菌病中国诊治指南(2024版)
中华医学会妇产科学分会感染性疾病协作组
作者及单位信息
·
DOI: 10.3760/cma.j.cn112141-20240326-00185
Chinese guidelines for diagnosis and treatment of vulvovaginal candidiasis (2024 edition)
Cooperative Group of Infectious Disease, Chinese Society of Obstetrics and Gynecology, Chinese Medical Association
Authors Info & Affiliations
Cooperative Group of Infectious Disease, Chinese Society of Obstetrics and Gynecology, Chinese Medical Association
·
DOI: 10.3760/cma.j.cn112141-20240326-00185
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摘要

外阴阴道假丝酵母菌病(VVC)是临床常见的生殖道炎症,造成患者外阴瘙痒、分泌物增多等不适,白假丝酵母菌是其最常见的致病原。诊断VVC推荐使用革兰染色涂片显微镜检查,观察到假菌丝及芽生孢子即可诊断;真菌培养推荐用于治疗困难或反复发作患者。诊断VVC后推荐进行分类,区分单纯性及复杂性VVC。单纯性VVC的治疗选用单疗程药物。复杂性VVC的治疗变化较大:重度VVC建议延长疗程;复发性VVC建议强化治疗后巩固治疗;妊娠期VVC禁用口服抗真菌药物,推荐阴道唑类药物治疗;非白假丝酵母菌感染或耐药假丝酵母菌感染推荐非唑类抗真菌药物或者依据真菌培养选择药物;VVC再发建议巩固治疗1~2个疗程;VVC合并混合感染建议同时治疗;VVC的抗真菌治疗联合使用微生态制剂推荐用于治疗无效或反复发作的患者。

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中华医学会妇产科学分会感染性疾病协作组. 外阴阴道假丝酵母菌病中国诊治指南(2024版)[J]. 中华妇产科杂志,2024,59(07):499-504.

DOI:10.3760/cma.j.cn112141-20240326-00185

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外阴阴道假丝酵母菌病(vulvovaginal candidiasis,VVC)曾称外阴阴道念珠菌病,是临床常见的阴道炎症,由假丝酵母菌引发,造成女性外阴瘙痒、分泌物增多等不适。基于目前国内外对VVC的认识,在2004年发布的《外阴阴道念珠菌病诊治规范(草案)》及2012年发布的《外阴阴道假丝酵母菌病(VVC)诊治规范修订稿》的基础上,中华医学会妇产科学分会感染性疾病协作组汇总近年来国内外研究进展,遵循《中国制订/修订临床诊疗指南的指导原则(2022版)》 1,结合中国临床实际,制订了《外阴阴道假丝酵母菌病中国诊治指南(2024版)》,阐述了VVC的诊疗原则及具体方案。
本指南由中华医学会妇产科学分会感染性疾病协作组发起成立的多学科工作组制订,主要涵盖妇科、产科、感染科及循证医学等学科的专家。证据的检索和评价由中华医学会妇产科学分会感染性疾病协作组与中国人民大学社会与人口学院共同完成。在PubMed、EMBASE、Cochrane等英文文献数据库中,以“vulvovaginal candidiasis”为关键词进行文献检索,检索时间为建库至2024年1月;在中国知网、万方数据知识服务平台、维普中文期刊数据库中进行文献检索,检索时间为建库至2024年1月。采用推荐意见分级的评估、制订和评价(grading of recommendations assessment,development and evaluation,GRADE)方法评价证据质量和推荐强度分级 2,见 表1
类别 解释
证据质量 多大程度上能够确信效应评估的正确性
高(A) 非常确信真实的效应值接近效应估计值
中(B) 对效应估计值有中等程度的信心:真实值有可能接近估计值,但仍存在两者大不相同的可能性
低(C) 对效应估计值的确信程度有限:真实值可能与估计值有很大不同
极低(D) 对效应估计值的确信程度几乎没有信心:真实值可能与估计值极大不同
推荐强度 多大程度上能够确信遵守推荐意见利大于弊
强(1) 明确显示干预措施利大于弊或弊大于利
弱(2) 利弊不确定或无论质量高低的证据均显示利弊相当
GRADE方法的证据质量与推荐强度分级

注:GRADE表示推荐意见分级的评估、制订和评价

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备注信息
A
刘朝晖,首都医科大学附属北京妇产医院妇科,北京 100026,Email: nc.defudabe.umcciuhoahzuil
B

国际实践指南注册与透明化平台,PREPARE-2024CN223

C
中华医学会妇产科学分会感染性疾病协作组. 外阴阴道假丝酵母菌病中国诊治指南(2024版)[J]. 中华妇产科杂志, 2024, 59(7): 499-504. DOI: 10.3760/cma.j.cn112141-20240326-00185.
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