Abstract:

Objective: To analyze the influencing factors of anti-tuberculosis drug-induced liver injury (ATB-DILI) in patients with pulmonary tuberculosis complicated with diabetes mellitus (PTB-DM). Methods: A prospective cohort study was conducted to continuously enroll 458 inpatients with PTB-DM who met the enrollment criteria from October 2017 to March 2019 in the North Branch of Qingdao Central Hospital. Before their treatment, we collected information of age, gender, marital status, education level, occupation, diet, smoking, drinking, physical activity level, clinical symptoms of tuberculosis, body mass index, blood biochemical index, blood routine index, blood glucose control level,usage and types of liver protection drugs through a self-designed structured questionnaire; after following-up for eight months, a multivariate Cox proportional hazard regression was done to analyze the occurrence of ATB-DILI and its influencing factors. Results: Among 458 PTB-DM patients,53 patients developed ATB-DILI, with an incidence rate of 11.6%. After adjusting for confounding factors such as smoking, physical activity, liver protection drugs and anemia, it was found that poor glycemic control (HR (95%CI)=2.787 (1.256-6.183)), drinking (HR (95%CI)=2.159 (1.097-4.251)), low weight (body mass index <18.5) (HR (95%CI)=2.808 (1.391-5.670)) and insufficient dietary diversity (HR (95%CI)=3.199 (1.372-7.459)) were risk factors for ATB-DILI in PTB-DM patients. Conclusion: Patients with PTB-DM were prone to develop ATB-DILI after anti-tuberculosis treatment, especially for those who had drinking habits, with low weight and inadequate dietary diversity, they were associated with a higher risk of ATB-DILI.

Key words: Tuberculosis,pulmonary, Diabetes mellitus, Drug-induced liver injury, Comorbidity, Factor analysis,statistical