Abstract: Objective This study aimed to investigate the efficacy of N-acetylcysteine (NAC) and dicyclol combination in the treatment of patients with antituberculous drugs-induced liver injury (DILI). Methods Seventy-six patients with DILI caused by anti-tuberculocidal agents for pulmonary tuberculosis were enrolled in our hospital between January 2018 and January 2020, and were randomly divided into group A and group B, with 38 cases in each group. All patients received symptomatic supporting treatment and nutritional supplement without discontinuing antituberculosis medication. The patients in group A were treated with bicyclol, and those in group B received bicyclol and NAC combination therapy for one month or didn't stop until serum liver function tests recovered. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TBIL), gamma glutamine transferase (GGT), superoxide dismutase (SOD), malondialdehyde (MDA), interleukin-6 (IL-6) and C-reactive protein (CRP) levels were detected. Results At the end of treatment, serum AST, ALT and GGT levels in group B were (39.3±10.5)U/L, (35.9±32.5)U/L and (58.4±10.5)U/L, significantly lower than [(75.4±14.6)U/L, (86.9±44.8)U/L and (95.8±14.5)U/L, respectively, P<0.05] in group A; serum SOD level was (83.5±8.0)U/L, significantly higher than [(74.5±7.3)U/L, P<0.05], while serum MDA, IL-6 and CRP levels were (5.0±0.8)μmol/L, (4.1±1.2)ng/L and (9.1±2.2)mg/L, all significantly lower than [(6.9±1.2)μmol/L, (6.8±2.4)ng/L and (14.5±3.7)mg/L, respectively, P<0.05] in group A; the complications such as dizziness, diarrhea, rash, fever, and nausea and vomiting in the two groups were not significantly different (18.4% vs. 15.8%, P>0.05). Conclusion The administration of bicyclol and NAC combination in treatment of patients with DILI caused by anti-tuberculosis agents could achieve a good curing efficacy with improved recovery of liver function index, which might be related to the inhibition of oxidative stress and inflammatory reactions. The long-term efficacy still needs further observation.

Key words: Drug-induced liver injury, Anti-tuberculous agents, N-acetylcysteine, Bicyclol, Therapy