Objective To explore the correlation between the degree of liver damage and clinical manifestations in patients with pulmonary tuberculosis after chemotherapy. Methods This study included 3620 new smear- positive pulmonary tuberculosis patients treated with first- line anti- tuberculosis drug in the Second Central Hospital of Baoding from January 2008 to January 2014,and the follow- up study was carried out to observe medication use and side effects of anti- tuberculosis drug treatment. Comparison of categorical data was made by chisquare test. Results A total of 1225 patients( 33. 8%) exhibited clinical manifestations related to liver injury. The most common clinical manifestation was nausea and vomiting( 72. 9%),followed by fatigue( 37. 8%),rash( 31. 5%),abdominal distension and diarrhea( 28. 1%),fever( 14. 2%),anorexia( 3. 8%),and other manifestations( 2. 0%). The nausea and vomiting usually first appeared and were followed by abdominal distension and diarrhea. Of all patients,243 cases( 6. 7%) suffered from liver damage and 109 cases( 3. 0%)had moderate to severe liver damage. Of the patients with clinical manifestations,171 cases( 14. 0%) had liver damage and 74 cases( 6. 0%) suffered from moderate to severe liver damage. Compared with the patients without clinical manifestations,the relative risks of liver damage and moderate to severe liver damage were 4. 643 [95% confidence interval( CI) = 3. 035- 4. 856]and 4. 134( 95% CI = 2. 817-4. 351),respectively,in the patients with clinical manifestations. The patients with fatigue,nausea and vomiting,rash,abdominal distension and diarrhea,anorexia,and other manifestations had higher risk of liver damage and moderate to severe liver damage than those without clinical manifestations( P < 0. 05) and the patients with anorexia showed the highest risk. Conclusion One third of patients with pulmonary tuberculosis have liver injury- related clinical manifestations after chemotherapy. Patients with fatigue,nausea and vomiting,rash,abdominal distension and diarrhea,anorexia,and other manifestations are more susceptible to liver damage and moderate to severe liver damage.