GSTM1 and GSTT1 genetic polymorphisms and risk of anti-tuberculosis drug-induced hepatotoxicity: an updated meta-analysis

  • C. Li
  • J. Long
  • X. Hu
  • Y. ZhouEmail author


The results of studies investigating the associations between GSTM1 and GSTT1 polymorphisms and anti-tuberculosis drug-induced hepatotoxicity (ADIH) risk exhibit much controversy. Therefore, a meta-analysis was performed in order to examine the associations between GST variants and ADIH risk. A total of 451 relevant studies were identified through the digital medical databases Medline, Embase, and CBM published up to October 2012. Thirteen individual case–control studies were eventually recruited for GSTM1 null polymorphism (including 951 ADIH cases, 1,922 controls) and 12 studies for GSTT1 null polymorphism (847 cases, 1,811 controls). Pooled odds ratios (ORs) and 95 % confidence intervals (CIs) were appropriately calculated from fixed-effects or random-effects models. Subgroup analyses were stratified by ethnicity and different treatment combinations. The overall ORs of relevant studies that exhibited elevated ADIH risk was significantly associated with GSTM1 null genotypes (OR = 1.36, 95 % CI 1.04–1.79), but for the GSTT1 polymorphism, no difference was found (OR = 0.98, 95 % CI 0.82–1.18). In the subgroup analyses, the pooled results showed that GSTM1 null allele carriers had a significant association with ADIH risk in East Asians and the patients who used isoniazid (INH) + rifampicin (RMP) + pyrazinamide (PZA) + ethambutol (EMB), or + streptomycin (SM) (HRZES), but the opposite result was observed for patients using HR. Moreover, the GSTT1 null genotype evaluated the susceptibility to ADIH for tuberculosis using HRZ. This meta-analysis provides evidence that there may be an increased risk of ADIH in individuals with null genotypes of GSTM1 in the total population, especially East Asians and patients receiving HRZE or HRZES. However, polymorphisms of the GSTT1 null genotype seem to have no association with susceptibility to ADIH, except for patients receiving HRZ.


GSTM1 Null Genotype GSTT1 Null Genotype Funnel Plot Asymmetry GSTT1 Polymorphism GSTM1 Polymorphism 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We are thankful to all the participants of our study. This study was not supported by any grants.

Conflict of interest

We declare that we have no conflict of interest.


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© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.School of Public HealthGuangxi Medical UniversityNanningPeople’s Republic of China

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