Shen Yi, Liu Jianping
Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China.
Department of Tuberculosis, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China.
Medicine (Baltimore). 2025 Aug 29;104(35):e44078. doi: 10.1097/MD.0000000000044078.
The risk of antituberculosis drug-induced liver injury (AT-DILI) in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) is not clear. The aim of this study was to investigate incidence and risk factors associated with AT-DILI in MASLD patients. Retrospectively, a total of 120 MASLD patients who received antituberculosis medication from December 2017 to March 2023 were reviewed, including 91 males and 29 females. The participants were categorized into 2 cohorts based on the presence or absence of liver injury. Risk factors for AT-DILI were analyzed using logistic regression analysis. Among the 120 patients with treatment of tuberculosis complicated with MASLD, 28 (23.3%) patients developed AT-DILI. The remaining 92 (76.7%) patients did not develop AT-DILI. In the group of patients with liver injury, there were 26 cases of mild liver injury, one case of moderate liver injury, and one case of acute liver failure. Additionally, there were 23 cases of hepatocellular injury, 3 cases of cholestasis, and 2 cases of mixed liver injury. AT-DILI was observed during antituberculosis treatment 30.4 ± 17.6 days after the treatment began. There were significant differences in age, body mass index (BMI), platelet count, total bilirubin, fibrosis-4 (FIB-4) between the liver injury group, and the non-liver injury group (P < .05 in all). There were no significant differences in gender, hemoglobin, albumin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, γ-glutamyltransferase, total cholesterol, triglyceride, combined hypertension, and combined diabetes mellitus between the liver injury group, and the non-liver injury group (P > .05 in all). By logistic regression analysis, low BMI and FIB-4 were a high-risk factor for liver injury. The incidence of AT-DILI was high in patients with pulmonary tuberculosis complicated with MASLD. Clinicians should focus on the risk of AT-DILI in patients with low BMI and elevated FIB-4 scores.
代谢功能障碍相关脂肪性肝病（MASLD）患者发生抗结核药物性肝损伤（AT-DILI）的风险尚不清楚。本研究旨在调查MASLD患者中AT-DILI的发生率及相关危险因素。回顾性分析了2017年12月至2023年3月期间接受抗结核治疗的120例MASLD患者，其中男性91例，女性29例。根据是否发生肝损伤将参与者分为2个队列。采用逻辑回归分析AT-DILI的危险因素。在120例肺结核合并MASLD患者中，28例（23.3%）发生AT-DILI。其余92例（76.7%）患者未发生AT-DILI。肝损伤组中，轻度肝损伤26例，中度肝损伤1例，急性肝衰竭1例。此外，肝细胞损伤23例，胆汁淤积3例，混合性肝损伤2例。AT-DILI在抗结核治疗开始后30.4±17.6天被观察到。肝损伤组和非肝损伤组在年龄、体重指数（BMI）、血小板计数、总胆红素、纤维化-4（FIB-4）方面存在显著差异（均P<0.05）。肝损伤组和非肝损伤组在性别、血红蛋白、白蛋白、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、碱性磷酸酶、γ-谷氨酰转移酶、总胆固醇、甘油三酯、合并高血压和合并糖尿病方面无显著差异（均P>0.05）。通过逻辑回归分析，低BMI和FIB-4是肝损伤的高危因素。肺结核合并MASLD患者中AT-DILI的发生率较高。临床医生应关注低BMI和FIB-4评分升高患者发生AT-DILI的风险。
