Analysis Of Risk Factors For Anti-tuberculosis Drug-induced Liver Injury In Patients With Primary Anti-tuberculosis Treatment

Objective: To investigate the risk factors of anti-tuberculosis drug-induced liver injury(ATB-DILI)in newly diagnosed tuberculosis patients,and to provide scientific theoretical support for reasonably avoiding the occurrence of ATB-DILI in tuberculosis patients receiving anti-tuberculosis drug treatment for the first time.Methods: A retrospective case-control study was carried out in 177 newly diagnosed tuberculosis patients admitted to the Third Hospital of Hebei Medical University from January 2014 to December 2019.According to whether ATB-DILI occurred during anti-tuberculosis treatment,the patients were divided into non-ATB-DILI group and ATB-DILI group.General basic data such as gender,age,body mass index,albumin,alanine aminotransferase,aspartate aminotransferase,total bilirubin,direct bilirubin,alkaline phosphatase,prothrombin time,whether serum ferritin is higher than normal,basic liver condition and the type and quantity of hepatotoxic anti-tuberculosis drugs were collected.Single-factor and multi-factor logistic regression analysis were adopted to analyze some factors those were of great clinical value and may induce ATB-DILI in tuberculosis patients with initial treatment including the basic liver condition(no basic liver disease;chronic non-viral liver disease;chronic viral liver disease),the type and quantity of hepatotoxic anti-tuberculosis drugs(three kinds,isoniazid + rifampicin + pyrazinamide;two kinds,isoniazid + rifampicin;one kind,isoniazid;none),ALT baseline level and whether serum ferritin is higher than normal.The odds ratio was used as the effect index.Results: ATB-DILI occurred in 36 of 177 newly diagnosed tuberculosis patients,with an incidence of 20.3 %.Multivariate logistic regression analysis showed that chronic viral liver disease(OR=12.385,P=0.000)and high serum ferritin baseline level(OR=2.925,P=0.038)were high risk factors for ATB-DILI in newly diagnosed patients with tuberculosis.The ALT baseline level(OR=1.019,P=0.005)was positively correlated with the occurrence of ATB-DILI.Compared with the application of three kinds of hepatotoxic anti-tuberculosis drugs(isoniazid+ rifampicin + pyrazinamide),the application of two kinds of hepatotoxic anti-tuberculosis drugs(isoniazid + rifampicin)and one kind of hepatotoxic anti-tuberculosis drug(isoniazid)reduced the risk of ATB-DILI by nearly 94.8%(OR=0.052,P=0.003)and 98.0%(OR=0.020,P=0.002),respectively.Reducing the quantity of hepatotoxic anti-tuberculosis drugs may be a protective factor for ATB-DILI.Conclusion: Tuberculosis patients with chronic viral liver disease,high serum ferritin baseline level and high alanine aminotransferase baseline level are the independent risk factors for ATB-DILI.