Study on the Optimization of Diagnostic and Therapeutic Pathways for Immunosuppressed Hosts with Severe Tuberculosis and Anti Tuberculosis Drug-Induced Liver Injury

TIAN Shijiang; FU Weiwei

doi:10.13919/j.issn.2095-6274.ZHJY202504038

Abstract：Objective To investigate the value of optimized diagnostic and therapeutic pathways in pa-tients with immunosuppression combined with severe tuberculosis and anti-tuberculosis drug-induced liver in-jury.Methods Sixty-eight patients with immunosuppression combined with severe tuberculosis and anti-tu-berculosis drug-induced liver injury were selected from the Department of Infectious Diseases at Wuchuan Gelao and Miao Autonomous County People's Hospital,from December 2022 to December 2024.Patients were randomly assigned into an observation group(n=34,receiving optimized diagnostic and therapeutic pathways)and a control group(n=34,receiving traditional empirical treatment).The treatment efficacy for severe tuberculosis,liver func-tion indices,coagulation function,and prognosis were compared between the two groups.Results The observa-tion group had significantly higher sputum conversion rates(85.29％vs.61.76％,P=0.028)and pulmonary tubercu-losis lesion absorption rates(64.71％vs.38.24％,P=0.029)compared to the control group.Before treatment,there were no significant differences in liver function indices[alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin]and coagulation indices[prothrombin time(PT),international normalized ratio(INR),and activated partial thromboplastin time(APTT)]between the two groups.After treatment,both groups showed sig-nificant reductions in these liver function and coagulation indices;however,the reductions were more pronounced in the observation group,with significantly lower lev-els of ALT(P=0.002),AST(P=0.007),total bilirubin(P=0.001),PT(P=0.021),INR(P=0.001),and APTT(P=0.001)compared to the control group.The 6-month survival rate(94.12％vs.76.47％,P=0.040)and 1-year survival rate(88.24％vs.64.71％,P=0.022)were also significantly higher in the observation group.Conclu-sion The optimized diagnostic and therapeutic pathways are feasible and highly effective,significantly improving liver function,coagulation function,and prognosis in patients with immunosuppression combined with severe tu-berculosis and anti-tuberculosis drug-induced liver injury.