Abstract: Objective The aim of this study was to investigate the preventive efficacy of liver-protecting medicines on the incidence of drug-induced liver injury (DILI). Methods A total of 324 patients with tubercular pleurisy and/or pulmonary tuberculosis were encountered in our hospital between March 2015 and March 2022, and all received standardized six-month anti-tubercular therapy. Simultaneously, the patients were randomly divided into group A (n=80), group B (n=81), group C (n=80) and group D (n=83), receiving oral silibinin, compound glycyrrhizin, polyene phosphatidyl choline and no liver-protecting medicine administration, respectively, until the discontinuation of anti-tubercular therapy. Serum interleukin-2 (IL-2), IL-10 and tumor necrosis factor-ɑ (TNF-ɑ) levels were detected by ELISA. Results The incidences of DILI in group A, group B, group C were 22.5%, 27.2% and 21.3%, all significantly lower than 45.8%(P<0.05) in group D; serum peak levels of biochemical parameters in the four groups with DILI were not significantly different (P>0.05), while at the end of six-month anti-tubercular therapy, serum ALT, AST and bilirubin levels in group A were (43.3±5.1)U/L, (36.9±5.0)U/L and (22.1±4.6)μmol/L, in group B were (54.3±5.3)U/L, (37.5±4.5)U/L and (13.5±4.4)μmol/L, and in group C were (39.1±5.5)U/L,(34.6±4.1)U/L and (18.6±4.4)μmol/L, all significantly lower than [(99.0±5.4)U/L, (146.5±14.8)U/L and (54.3±4.4)μmol/L, respectively, P<0.05] in group D; there were no significant differences respect to serum peak cytokine levels in the four groups(P>0.05); at the end of anti-tubercular therapy, serum IL-2 and IL-10 in group A were (149.3±3.0)ng/L and (50.1±5.7)ng/mL, in group B were (146.3±3.1)ng/L and (27.3±4.4)ng/mL, and in group C were (143.2±3.5)ng/L and (82.9±5.9)ng/mL, all significantly higher than [(72.6±3.7)ng/L and (25.3±5.1)ng/mL, while serum TNF-α levels in group A, B and C were (2.2±0.5)ng/mL, (2.3±0.4)ng/mL and (2.3±0.4)ng/mL, all significantly lower than [(13.0±0.5)ng/mL, P<0.05] in group D. Conclusion The application of liver-protecting medicines could remarkably reduce the incidence of DILI, relieve liver injuries, which might guarantee the anti-tubercular therapy going.

Key words: Drug-induced liver injury, Tuberculosis, Silibinin, Compound glycyrrhizin, Polyene phosphatidyl choline, Prevention