Correction of toxic impact of anti-tuberculosis drugs on the liver in patients with first-time diagnosis of pulmonary tuberculosis

Abstract

Introduction. The liver, being the main organ of detoxification, is experiencing the greatest burden in the process of chemotherapy. Disorders of the liver function in patients with respiratory tuberculosis can occur due to various factors, leading to the development of toxic reactions up to acute and chronic hepatitis. Numerous studies point to pronounced hepatotoxic effect of all anti-TB drugs and development of toxic hepatitis in patients treated with these drugs. This suggests the need to use hepatotropic drugs in complex treatment of TB.The aim of the study – to learn biochemical markers of liver function abnormalities in patients with newly diagnosed pulmonary tuberculosis and with severe intoxication syndrome before and two months after TB inpatient treatment, and the feasibility of using domestically-produced “Antral“ medication to treat functional disorders of the liver in these patients.Research methods. Two groups of people were involved in the study. Group I (control) consisted of evidently healthy donors, 27 individuals; Group II (31 individuals) consisted of patients with newly diagnosed pulmonary tuberculosis and with severe intoxication syndrome before and two months after of anti-TB therapy. This group was randomly divided into two subgroups: IIA(15 individuals), patients that only received standard anti-TB treatment and IIB (16 individuals), patients along with the standard anti-TB therapy received “Antral“ medication in the dose of 200 mg 3 times a day for the duration of treatment intensive phase. Results and Discussion. Results of the study indicate that when examining patients with pulmonary tuberculosis and severe intoxication syndrome markers of cytolysis and cholestasis should be measured prior to start of the treatment. With the increase of such indicators, in particular, ALT, AST, general and direct bilirubin, LDH, GGTP should be appointed hepatoprotector, in particular "Antral" drug. The use of this drug during the intensive phase of treatment normalizes the parameters of not only cytolytic but also cholestatic syndromes of liver function disorders in patients. Use of this medication in the treatment of tuberculosis contributed to ceasing release of the bacteria after intensive phase of treatment in 71.2 % of cases in subgroup IIB (43.9 % in subgroup IIA), and disappearance of clinical manifestations of intoxication in subgroup IIB in 79.8 % of cases (49.6 % in subgroup IIA). Significant reduction in markers of cytolysis and cholestasis was observed in patients that received “Antral“ medication during intensive phase of the treatment.Conclusions. Patients with newly-detected pulmonary tuberculosis and severe intoxication syndrome had significantly increased markers of cytolysis and cholestasis even before start of the treatment. “Antral“ is a medication with hepatoprotective action. Use of this medication alongside with the complex therapy of pulmonary tuberculosis contributed to normalization of liver function, significant reduction in the markers of cytolysis and cholestasis, faster termination of bacterial release and disappearance of clinical manifestations of intoxication.