China is a large country with liver disease, and TB is a high incidence in China. Combination short-course chemotherapy regimens are the primary measures to treat TB patients and control the TB epidemic. 2HRZE /4HR regimen (isoniazid, rifampicin, pyrazinamide and ethambutol once daily for the first 2 months and continued with isoniazid and rifampicin once daily for the second 4 months) is the common regimen for patients with primary sputum-positive TB. Most anti-tuberculosis drugs have varying degrees of liver damage, especially in those with pulmonary tuberculosis associated with chronic liver disease, which can be without any clinical symptoms. However, it is important to be clinically alert to the effect of anti-tuberculosis chemotherapy on the liver function of TB patients who also have chronic liver disease, otherwise, it may lead to very serious consequences. Combination chemotherapy is the best regimen for the treatment of tuberculosis, and drug-related liver damage is the most common and serious toxic side effect of anti-tuberculosis drugs. This damage can interfere with treatment and even interrupt chemotherapy and lead to worsening of tuberculosis. Many data show that the incidence of liver damage caused by chemotherapy in patients with tuberculosis combined with liver disease can be more than 40%, which is higher than the incidence of liver damage caused by anti-tuberculosis drugs in the general population (about 10%), and the liver damage is more serious. The mechanism of liver damage caused by anti-tuberculosis drugs is quite complex, and may have the following two aspects: (1) interference with the metabolic process of hepatocytes, leading to biliary stasis, fatty degeneration and necrosis; (2) destruction of hepatocytes by poisoning the basic structure of hepatocytes, eventually leading to hepatocyte necrosis. Abnormal liver function in patients with various liver diseases may be related to pre-existing pathological changes in the liver. Patients with tuberculosis in combination with liver disease tend to have more severe impairment of liver function. Patients with chronic liver disease take longer to return to normal liver function after anti-tuberculosis and have more severe symptoms, and most patients need to discontinue their medication, and often need to adjust their treatment regimen after liver function returns to normal, especially in those with cirrhosis. This indicates that the time of occurrence, degree and speed of recovery of liver damage are closely related to the original underlying liver disease. Drug-related liver damage often occurs within the first 2 months of drug use, but in some patients it can occur after 3 months of drug use. Liver function should be routinely tested before the drug is administered, and should be rechecked semi-monthly within 3 months after the drug is administered, and weekly if there are suspected symptoms of liver damage. It is still very important to review liver function every month in the future to facilitate early and timely detection of liver damage, especially when symptoms such as nausea, aversion to oil and weakness appear, and to be alert to the occurrence of liver damage and timely discontinuation of anti-tuberculosis drugs to avoid rapid liver necrosis and life-threatening effects. Other liver disease-related tests, such as ultrasound and hepatitis virology, should also be performed before antituberculosis chemotherapy to detect potential liver disease without symptomatic manifestations. Those with chronic liver disease, especially cirrhosis, should be actively reviewed for liver function and, if necessary, for targeted treatment of liver disease and aggressive liver protection therapy.