Effects Of Hepatoprotective Drugs And Nutritional Status Of Patients With Tuberculosis On Liver Injury Induced By Anti-tuberculosis Drugs

Objective: Hepatoprotective drugs have been used as routine drugs to prevent and treat liver injury or hepatotoxicity induced by anti-tuberculosis drug(ATDH),but the effect is still controversial.Therefore,we aimed to explore the effectiveness of hepatoprotective drugs on the improvement of liver function in patients with anti-tuberculosis therapy and the influence of nutritional status in TB(tuberculosis,TB)patients on their liver function.Methods: A total of 1730 new TB patients from the chest Hospital in Linyi and Qingdao and two Junction and Prevention Center in Lin Yin were selected as subjects.Collect demographic information,such as age,sex,etc.,as well as the results of weekly biochemical examination,and the use of tuberculosis drugs and hepatoprotective drugs.According to the number of hepatoprotective drugs,the subjects were divided into group 1,gruop 2 and group 3,which was treated with one,two and three hepatoprotective drugs,respectively.ATDH refers to liver injury caused by first-line antituberculous drugs(excluding other factors),and the level of alanine transaminase(ALT)was higher than 2 times the normal upper limit of normal(ULN),or aspartate aminotransferase(AST)and the total bilirubin(TBIL)increased along,and one of them exceeded 2*ULN.Nutrition indicators: body mass index [BMI(kg/m2): <18.5 is defined as malnutrition(marasmus),18.5~23.9 is normal,and more than or equal to 24 is overweight or obese)];peripheral blood lymphocytes count [TLC: <2.0×109/L is defined as malnutrition(TLC reduction),2~3.2 is normal];serum albumin count [ALB(g/L): <35 is defined as malnutrition(hypoproteinemia),35~55 is normal].Result:Once given the anti-tuberculosis medication,all TB patients were treated with hepatoprotective drugs,and 17.7%,45.3% and 37.0% of whom were treated with 1 kind,2 kinds and 3 kinds of hepatoprotective drugs,respectively.Of the 1730 TB patients,152 patients happen being liver injury.During the first month of anti-tuberculosis treatment,the incidence of liver injury in TB patients used hepatoprotectants in group 1,2and 3 was 8.50%,8.17% and 9.67%,respectively(P>0.05).Percentages of abnormal ALT exceeding the normal upper limit value were 6.86%,6.64% and 7.96%,respectively;and of abnormal glutamic oxaloacetic transaminase exceeding the normal upper limit being 5.56%,4.47% and 5.77% in group 1,2and 3,respectively;but there was no significant difference among the three groups(P>0.05).The nutritional status of TB patients was related to the liver function.The risk of ATDH in TB patients with ALB,TLC and BMI dystrophy were 1.97 times,1.92 times and 3.26 times as high as those with normal ALB,TLC and BMI respectively.Compared with patients with TB and normal ALB before the anti-tuberculosis treatment,the risk(after adjusted by gender and age)of liver injury increased by 74% in TB patients with mild malnutrition and 132% in moderate and severe malnutrition.Compared with patients with TB and normal TLC before the anti-tuberculosis treatment,the RR(after adjusted by gender and age)of liver injury increased by 55%,124% and 224 % in the mild,moderate and severe malnutrition groups,respectively.After adjusted by gender and age,the risk of liver injury(in the third or fourth week of anti-tuberculosis treatment)in groups which changed from normal nutrition before treatment to malnutrition at the second week increased by 202%.After adjusted by gender and age,compared with those who had improved to normal nutrition at the second week after dietary nutrition improvement,the risk of liver injury(in the third or fourth week of anti-tuberculosis treatment)in patients with TB who were still ALB malnutrition increased by 350%.Conclusion: Compared with single hepatoprotective drugs,multiple hepatoprotective drugs could not significantly improve liver injury induced by anti-tuberculosis drugs in TB patients without risk factors of liver injury;The worse the nutritional status of TB patients is,the higher the risk of liver injury will be;and improving the nutritional status of patients with TB(especially ALB)is conducive to the prevention of the occurrence of liver injury.