超声电导透皮给药在结核病辅助治疗中的应用与展望

doi:10.19982/j.issn.1000-6621.20260284

摘要/Abstract

摘要：

超声电导透皮给药治疗结核病具有靶向精准、无创安全、病灶局部药物浓度高等优势,是一项重要的结核病治疗新思路、新措施。笔者系统阐述了超声电导透皮给药的机制与原理,各种结核病治疗的适应证与禁忌证、治疗前的评估与准备、治疗药物、并发症防治及治疗后管理等内容,同时展示了该技术未来在结核病辅助治疗中的发展前景,可为临床医务人员提供标准化操作指导,提升此项技术在结核病辅助治疗应用中的安全性与规范性。

关键词: 超声透入疗法, 结核, 治疗学

Abstract:

Ultrasound-mediated transdermal drug delivery is a new drug treatment method, which has the advantages of precision, non-invasiveness, safety, local high concentration, and is an important new idea and new measure for tuberculosis treatment. This article systematically elaborated the mechanism and principle of ultrasound-mediated transdermal drug delivery, the indications and contraindications of various tuberculosis treatments, the evaluation and preparation before treatment, the operation process of treatment, the selection of therapeutic drugs, the prevention and treatment of complications, and the management after treatment. The aim is to provide clinical medical staff with operational practice guidance, help to improve the safety and standardization of this technology in the application of adjuvant treatment of tuberculosis, and show the future development prospects of this technology in the adjuvant treatment of tuberculosis.

Key words: Phonophoresis, Tuberculosis, Therapeutics

中图分类号:

R52
R454.3

钟乐萍, 秦世炳, 沙巍, 邓国防, 林明贵. 超声电导透皮给药在结核病辅助治疗中的应用与展望[J]. 中国防痨杂志, 2026, 48(9): 1245-1249. doi: 10.19982/j.issn.1000-6621.20260284

Zhong Leping, Qin Shibing, Sha Wei, Deng Guofang, Lin Minggui. Application and prospect of ultrasound-mediated transdermal drug delivery in adjuvant treatment of tuberculosis[J]. Chinese Journal of Antituberculosis, 2026, 48(9): 1245-1249. doi: 10.19982/j.issn.1000-6621.20260284

参考文献 48

[1]	Kumar R N H, Rao C R, Maradi R, et al. Incidence of adverse drug reactions among tuberculosis patients initiated on daily drug regimen in a southern district of Karnataka[J]. Perspect Clin Res, 2025, 16(1): 31-37. doi:10.4103/picr.picr_20_24. pmid: 39867528
[2]	Fellinger K, Schmid J. Klinik und Therapie des chronischen Gelenkrheumatismus[M]. Vienna: Verlag Wilhelm Maudrich, 1954.
[3]	Newman M K, Kill M, Frampton G. Effects of ultrasound alone and combined with hydrocortisone injections by needle or hypo-spray[J]. Am J Phys Med, 1958, 37(4): 206-209. pmid: 13559414
[4]	Tyle P, Agrawala P. Drug delivery by phonophoresis[J]. Pharm Res, 1989, 6(5): 355-361. doi:10.1023/a:1015967012253.
[5]	Bommannan D, Menon G K, Okuyama H, et al. Sonophoresis. Ⅱ. Examination of the mechanism (s) of ultrasound-enhanced transdermal drug delivery[J]. Pharm Res, 1992, 9(8):1043-1047. doi:10.1023/a:1015806528336.
[6]	Mitragotri S, Blankschtein D, Langer R. Ultrasound-mediated transdermal protein delivery[J]. Science, 1995, 269(5225):850-853. doi:10.1126/science.7638603. pmid: 7638603
[7]	Mitragotri S, Blankschtein D, Langer R. Transdermal drug delivery using low-frequency sonophoresis[J]. Pharm Res, 1996, 13(3):411-420. doi:10.1023/a:1016096626810.
[8]	Boucaud A, Montharu J, Machet L, et al. Clinical, histologic, and electron microscopy study of skin exposed to low-frequency ultrasound[J]. Anat Rec, 2001, 264(1):114-119. doi:10.1002/ar.1122. pmid: 11505377
[9]	Bae S, Liu K, Pouliopoulos A N, et al. Transcranial blood-brain barrier opening in Alzheimer’s disease patients using a portable focused ultrasound system with real-time 2-D cavitation mapping[J]. Theranostics, 2024, 14(11):4519-4535. doi:10.7150/thno.94206.
[10]	Meng Y, Goubran M, Rabin J S, et al. Blood-brain barrier opening of the default mode network in Alzheimer’s disease with magnetic resonance-guided focused ultrasound[J]. Brain, 2023, 146: 865-872. doi:10.1093/brain/awac459.
[11]	Abrahao A, Meng Y, Llinas M, et al. First-in-human trial of blood-brain barrier opening in amyotrophic lateral sclerosis using MR-guided focused ultrasound[J]. Nat Commun, 2019, 10(1):4373. doi:10.1038/s41467-019-12426-9.
[12]	Gasca-Salas C, Fernández-Rodríguez B, Pineda-Pardo J A, et al. Blood-brain barrier opening with focused ultrasound in Parkinson’s disease dementia[J]. Nat Commun, 2021, 12(1): 779. doi:10.1038/s41467-021-21022-9. pmid: 33536430
[13]	Mainprize T, Lipsman N, Huang Y, et al. Blood-brain barrier opening in primary brain tumors with non-invasive MR-guided focused ultrasound: A clinical safety and feasibility study[J]. Sci Rep, 2019, 9(1): 321. doi:10.1038/s41598-018-36340-0. pmid: 30674905
[14]	Anastasiadis P, Gandhi D, Guo Y, et al. Localized blood-brain barrier opening in infiltrating gliomas with MRI-guided acoustic emissions-controlled focused ultrasound[J]. Proc Natl Acad Sci U S A, 2021, 118(37): e2103280118. doi:10.1073/pnas.2103280118.
[15]	Meng Y, Reilly R M, Pezo R C, et al. MR-guided focused ultrasound enhances delivery of trastuzumab to Her2-positive brain metastases[J]. Sci Transl Med, 2021, 13(615): eabj4011. doi:10.1126/scitranslmed.abj4011.
[16]	刘清, 么焕新, 刘华, 等. 超声电导透皮给药与静脉给药后脑脊液及组织药物浓度相似[J]. 基础医学与临床, 2006(11):1264-1265. doi:10.3969/j.issn.1001-6325.2006.11.024.
[17]	Liu Q, Chen L, He J Q. Drug transdermal delivery by electrophonophoresis can increase the concentration of rifampicin in the pleural effusion of patients with tuberculous pleurisy but has no effect on the concentration of rifampicin in plasma[J]. Int Immunopharmacol, 2023, 117:109892. doi:10.1016/j.intimp.2023.109892.
[18]	Chen S, Han Y, Yu D, et al. Transdermal delivery of isoniazid and rifampin in guinea pigs by electro-phonophoresis[J]. Drug Deliv, 2017, 24(1):467-470. doi:10.1080/10717544.2016.1267275. pmid: 28181840
[19]	党萍, 王建梅, 侯莉莉, 等. 超声电导仪透药治疗初治菌阳空洞型肺结核临床疗效观察[J]. 贵州医药, 2017, 41(2):161-162. doi:10.3969/j.issn.1000-744X.2017.02.021.
[20]	毛晓辉, 王龙智, 蔡曙波, 等. 化疗联合超声电导经皮透药治疗复治空洞性肺结核的疗效评价[J]. 中国防痨杂志, 2014, 36(11): 936-940. doi:10.3969/j.issn.1000-6621.2014.11.003.
[21]	杨玉前, 翟瑶, 柳吕翩, 等. 四联抗结核药物联合利福平超声电导入治疗淋巴结核的效果评价[J]. 临床医学, 2021, 41(6):110-111. doi:10.19528/j.issn.1003-3548.2021.06.043.
[22]	马廷龙, 韩毅, 程序, 等. 超声抗结核药品电导入联合化疗对胸壁结核的疗效观察[J]. 中国防痨杂志, 2020, 42(9): 968-972. doi:10.3969/j.issn.1000-6621.2020.09.015.
[23]	毛晓辉, 曹思哲, 王勃, 等. 超声透药靶向治疗包裹性结核性胸膜炎临床疗效观察[J]. 临床肺科杂志, 2015, 20(12): 2156-2158. doi:10.3969/j.issn.1009-6663.2015.012.007.
[24]	王娅, 李佺, 杨澄清, 等. 辅助超声电导靶位透药治疗结核性胸膜炎的效果分析[J]. 临床肺科杂志, 2014, 19(12): 2258-2260. doi:10.3969/j.issn.1009-6663.2014.012.042.
[25]	李娟, 吴磊, 邓群, 等. 超声波辅助治疗粘连包裹型结核性腹膜炎疗效分析[J]. 实用临床医学, 2015, 16(9):17-19. doi:10.13764/j.cnki.lcsy.2015.09.007.
[26]	范俊, 秦世炳, 董伟杰, 等. 化疗联合经皮超声电导抗结核药物治疗早期膝关节结核[J]. 中国防痨杂志, 2016, 38(4): 262-265. doi:10.3969/j.issn.1000-6621.2016.04.006.
[27]	贾慧. 辅助超声引导靶向透药治疗结核性胸膜炎的临床疗效分析[J]. 当代医学, 2021, 27(5): 148-149. doi:10.3969/j.issn.1009-4393.2021.05.064.
[28]	齐凤荣, 陈柳, 李晓南, 等. 超声微波透入抗结核药物及激素在治疗粘连包裹型结核性腹膜炎中的疗效观察[J]. 当代医学, 2017, 23(32): 11-13. doi:10.3969/j.issn.1009-4393.2017.32.004.
[29]	Yang D, Kong Y. The bacterial and host factors associated with extrapulmonary dissemination of Mycobacterium tuberculosis[J]. Front Biol(Beijing), 2015, 10(3): 252-261. doi:10.1007/s11515-015-1358-y.
[30]	Rai D K, Kumar R, Ahmad S. Clinical characteristics and treatment outcome in Tubercular lymphadenitis patients-Aprospective observational study[J]. Indian J Tuberc, 2020, 67(4): 528-533. doi:10.1016/j.ijtb.2020.07.021.
[31]	高璐珏, 黄子慧, 王新方, 等. 淋巴结结核1082例临床分析[J]. 中国感染与化疗杂志, 2021, 21(5): 505-511. doi:10.16718/j.1009-7708.2021.05.001.
[32]	Ganchua S K C, White A G, Klein E C, et al. Lymph nodes-The neglected battlefield in tuberculosis[J]. PLoS Pathog, 2020, 16(8): e1008632. doi:10.1371/journal.ppat.1008632.
[33]	Ashenafi S, Muvva J R, Mily A, et al. Immunosuppressive Features of the Microenvironment in Lymph Nodes Granulomas from Tuberculosis and HIV-Co-Infected Patients[J]. Am J Pathol, 2022, 192(4): 653-670. doi:10.1016/j.ajpath.2021.12.013. pmid: 35092727
[34]	中国人民解放军总医院第八医学中心结核病医学部, 《中国防痨杂志》编辑委员会, 中国医疗保健国际交流促进会结核病防治分会. 浅表淋巴结结核的诊断与治疗专家共识[J]. 中国防痨杂志, 2023, 45(6): 531-542. doi:10.19982/j.issn.1000-6621.20230120.
[35]	Chen S, Qin M, Han Y, et al. Assessment of the efficacy of drug transdermal delivery by electro-phonophoresis in treating tuberculous lymphadenitis[J]. Drug Deliv, 2016, 23(5):1588-1593. doi:10.3109/10717544.2015.1124474.
[36]	万荣, 李明武, 朱惠琼, 等. 抗结核药物超声导入治疗淋巴结结核的临床观察[J]. 云南医药, 2016, 37(6):649-651.
[37]	万荣, 马萌, 范稚坚, 等. 超声靶位透药治疗颈部淋巴结结核的临床观察[J]. 大理大学学报, 2018, 3(10):44-46. doi:10.3969/j.issn.2096-2266.2018.10.010.
[38]	Massard G, Olland A, Santelmo N, et al. Surgery for the sequelae of postprimary tuberculosis[J]. Thorac Surg Clin, 2012, 22(3):287-300. doi:10.1016/j.thorsurg.2012.05.006. pmid: 22789594
[39]	赵吉庆, 郑文文. 探讨内科抗结核联合择机手术治疗胸壁结核的效果及复发情况[J]. 中国实用医刊, 2014, 41(15): 78-79. doi:10.3760/cma.j.issn.1674-4756.2014.15.035.
[40]	陈永芳, 任欣欣. 超声电导透药在结核性胸膜炎治疗中的应用价值[J]. 中国中西医结合影像学杂志, 2020, 18(6): 605-608. doi:10.3969/j.issn.1672-0512.2020.06.018.
[41]	刘阳, 邓爱花, 熊玉红. 超声电导仪经皮局部透药治疗结核性胸膜炎的临床效果观察[J]. 中国医药指南, 2014, 12(34): 236-237. doi:10.15912/j.cnki.gocm.2014.34.181.
[42]	韩莉, 桑杨, 刘云. 超声电导仪靶向透药联合胸腔内注入尿激酶治疗结核性包裹性胸膜炎的效果[J]. 医学综述, 2017, 23(3): 591-593, 597. doi:10.3969/j.issn.1006-2084.2017.03.041.
[43]	大会学术委员会. 骨关节结核诊疗共识(讨论稿)[J]. 结核病与肺部健康杂志, 2012, 1(3): 206-212.
[44]	张贺龙, 王慧燕, 刘威, 等. IGRA、LAM抗体联合Xpert技术检测对膝关节结核的诊断价值及与结核活动性的关系[J]. 临床误诊误治, 2021, 34(10): 84-87, 93. doi:10.3969/j.issn.1002-3429.2021.10.019.
[45]	张歌. 多学科协作护理对关节结核患者的效果及护理满意度的观察分析[J]. 临床研究, 2021, 29(10): 178-179.
[46]	骨关节结核临床诊断与治疗进展及其规范化专题研讨会学. 正确理解和认识骨与关节结核诊疗的若干问题[J]. 中国防痨杂志, 2013, 35(5): 384-392.
[47]	兰远波, 刘权贤, 黄璐, 等. 超声电导药物透入治疗骨和关节结核[J]. 临床医药文献电子杂志, 2014, 1(1): 14, 44. doi:10.16281/j.cnki.jocml.2014.01.113.
[48]	中华医学会结核病学分会. 结核病互联网诊疗专家建议[J]. 中华结核和呼吸杂志, 2024, 47(8): 738-745. doi:10.3760/cma.j.cn112147-20240207-00075.