Level of hepatic enzymes and serum zinc and copper at start of Anti-tubercular treatment (ATT) and a onset of hepatitis induced by ATT

Abstract

Background: Hepatitis is common adverse effect seen after starting anti tubercular treatment. Anti-tubercular drugs namely. Isoniazid, Rifampicin and Pyrazinamide are potentially Hepatotoxicity drugs. These drugs are metabolized by the liver. No Hepatotoxicity has been reported for Ethambutol or Streptomycin.

Objectives: The present study was performed to see the changes in serum levels of hepatic enzymes (SGOT. SGPT& ALT Phosphatase) & serum Bilirubin & Copper (Cu), zinc (Zn) microelements in tuberculosis patients having Hepatotoxicity after anti tuberculoid treatment (ATT). Methods: It was an a prospective longitudinal study. A total of 685 tuberculosis patients was included in study. Patients were treated with Isoniazid (H) 300mg, Rifampicin(R) 450mg. Pyrazinamide(Z) 1500mg Ethambutol (E) 1000mg for two months followed by IN14-300mg. Rifampicin 450mg for next four months. Serum levels of hepatic enzymes (SGOT, SGPT& ALT Phosphatase) & serum Bilirubin & Copper (Cu), zinc (Zn) microelements was estimated at start of ATT and after onset of hepatitis.

Results: Out of 685 patients, 46 patients developed Jaundice with Hepatomegaly within six weeks of treatment. SGOT, SGPT, serum Bilirubin & copper were increased significantly (p<0.05). Antitubercular drugs were withdrawn at the onset of jaundice. The level of serum zine declined significantly after hepatitis (p<0.05).

Conclusion: Serum SGOT. SGPT. Copper levels were increased at the onset of hepatitis when compared with the levels which obtained before start of ATT & zinc levels decreased after ATT. There was no significant changes found in serum levels of alkaline phosphatises