Clinical Analysis Of 137 Cases Of Drug-induced Liver Injury Caused By Anti-tuberculosis Drugs

Objective: The clinical characteristics of drug-induced liver injury induced by antituberculous drugs were analyzed retrospectively in order to explore and discuss the risk factors,clinical characteristics and prognostic factors of drug-induced liver injury.Methods: A total of 291 newly diagnosed tuberculosis patients who were treated with the 2HRZE/4HRE regimen and were included in the anti-tuberculosis drug during the period from January 2016 to January 2019 in the 3rd People’s Hospital of Guilin City were collected.The medical records of137 patients with liver damage within 2 months of the anti-tuberculosis treatment period were retrospectively analyzed.Results:1.Incidence rate: In this study,291 patients with tuberculosis（TB）who met the inclusion criteria,137 patients had anti-tuberculosis induced liver injury（ATDILI）during anti-tuberculosis treatment.The overall incidence was 47.08%（137/291）.2.The relationship between ATDILI onset and age: The risk of ATDILI in patients over 75 years old was higher than that in patients aged <18,18-44,45-59,and 60-74 years,but the difference between the groups was not statistically significant（P>0.05）.3.The gender distribution of ATDILI,including 84 female patients,34 patients with ATDILI,the prevalence rate was 40.48%（34/84）;207 male patients,103 patients with ATDILI,the prevalence rate was 49.76%（103/207）;the incidence of male patients was higher than that of female patients,and the difference was not statistically significant（P>0.05）.4.The risk of ATDILI in patients with blood-borne disseminated pulmonary tuberculosis and/or tuberculous meningitis was not statistically significant（P>0.05）.5.Is there a difference in the risk of ATDILI between patients with liver protection: 188 patients with tuberculosis,188 with anti-tuberculosis treatment plus hepatoprotective drugs,103 patients did not receive liver protection at the same time,the results showed that anti-tuberculosis treatment plus insurance There was a statistically significant difference in the risk of ATDILI between patients with liver drugs and patients with liver-protecting drugs at different times（P<0.05）.6.The difference in patient’s weight and ATDILI risk: patients with ATDILI had significantly lower body weight than patients without ATDILI,and the difference was statistically significant（P<0.05）.The incidence of ATDILI in the intensive period of anti-tuberculosis treatment was65.05% in the body weight <50Kg group and 37.23% in the body weight≥50Kg group.The difference between the two groups was statistically significant（P<0.05）.The incidence of ATDILI decreased with increasing body weight（P<0.05）.7.There were 25 cases of ATDILI patients with liver injury <7days（25/137,18.25%）,51 cases in 7-14 days（51/137,37.23%）,and 27 cases in15-28 days（27/137,19.71%）,>28 cases in 34 cases（34/137,24.82%）.The first week to the fourth week after the use of anti-tuberculosis drugs was the high incidence period of ATDILI（75.18%）.8.In this study,137 patients with ATDILI were mainly with fatigue,anorexia,and nausea as the main clinical manifestations.There were 95 cases of mild liver damage（95/137,69.34%）,33 cases of moderate liver damage（33/137,24.09%）,and 9 cases of severe liver damage（9/137,6.57%）.Age was a factor affecting the severity of ATDILI（P<0.05）.9.In 135 patients（135/137,98.54%）,the liver function index of ATDILI patients completely returned to normal,and 2 families of ATDLI patients gave up treatment and were discharged automatically.The factors affecting the recovery time of liver function are age,presence or absence of jaundice,and severity of liver function.The recovery time of liver function in patients aged <18 years was shorter than those in18-44 years old,45-59 years old,60-74 years old,75 years old and above（P<0.05）;patients with jaundice recovered longer than no jaundice and no Patients with obvious clinical manifestations（P<0.05）;liver function recovery time of patients with mild liver injury was shorter than that of moderate to severe liver injury（P<0.05）;there was no significant difference in liver function recovery time between patients of different genders（P>0.05）.Conclusion: 1.The high-risk period of ATDILI（75.91%）within 4 weeks after administration,therefore,close monitoring of liver function indicators is of great significance for early detection of ATDILI.2.The occurrence of ATDILI is significantly related to the weight of the patient,and its incidence decreases with the increase of body weight.3.Age is a factor affecting the severity of liver function and should be highly valued.4.The clinical manifestations of ATDILI are mostly fatigue,anorexia,and nausea.5.The recovery time of liver function is related to age,presence or absence of jaundice,and relevant severity of liver injury.However,most of the liver function can return to normal after treatment by stopping the drug and protecting the liver.Therefore,close monitoring of liver function changes and timely liver protection treatment are of great significance for the prevention and treatment of ATDILI.