Objective To explore the risk factors of antituberculosis treatment and construct a nomogram model. Methods The clinical data of 233 patients with pulmonary tuberculosis and anti-tuberculosis admitted to our hospital from September 2021 to September 2023 were retrospectively analyzed. The patients were divided into liver damage group and non-liver damage group according to whether liver function damage occurred. Multivariate logistic regression model was used to screen the risk factors for liver function damage. And R (R3.5.3) software was used to build a column-graph risk warning model for pulmonary tuberculosis and anti-tuberculosis treatment complicated with liver function damage, and its prediction efficiency was verified. Results Among 233 patients with pulmonary tuberculosis who received anti-tuberculosis treatment, 35 patients developed liver function impairment, and the incidence of liver function impairment was 15.02% (35/233). The occurrence time of liver damage was 2 ～ ＜ 4 weeks in 21 cases (60.00%), 4 ～ ＜8 weeks in 9 cases (25.71%), and ≥8 weeks in 5 cases (14.29%). There were 19 cases (54.29%) of mild liver damage, 12 cases (34.29%) of moderate liver damage, and 4 cases (11.43%) of severe liver damage. Multivariate Logistic regression analysis showed that age ≥ 60 years, BMI＜18.5 kg/m2, and malnutrition, alcohol consumption, non-treatment-naive patients, and having underlying liver diseases were all risk factors for liver function impairment in patients undergoing anti-tuberculosis treatment for pulmonary tuberculosis (P＜0.05); bootstrap repeated sampling 1000 times to obtain the correction curve, which was basically consistent with the ideal curve. The area under the ROC curve (AUC) was 0.842 (95%CI:0.776～0.907). The slope of the calibration curve was close to 1, and the Hosmer-Lemeshow goodness-fit test was good (R2=0.337, P=0.670). It indicates that the nomogram model of liver function impairment complicated by anti-tuberculosis treatment for pulmonary tuberculosis has high accuracy and feasibility. Conclusion This study initially found that age ≥ 60 years old, BMI＜18.5 kg/m2, malnutrition, alcohol consumption, non-initial treatment patients, and underlying liver diseases are risk factors affecting liver function impairment during anti-tuberculosis treatment for pulmonary tuberculosis. The nomogram model constructed based on these factors has demonstrated certain accuracy and feasibility in predicting liver function impairment concurrent with anti-tuberculosis treatment for pulmonary tuberculosis. However, given the relatively small sample size, the predictive efficacy and generalization ability of this model still need further verification and optimization