Objective To evaluate the clinical efficacy of silybin combined with nucleotides in the treatment of viral hepatitis associated with nonalcoholic fatty liver disease (NAFLD).Methods 88 viral hepatitis patients with NAFLD were randomly selected into the clinical research,and they were divided into groups according to the order of treatment.Among them 44 cases of single number were the control group treated with nucleoside(acid) drugs,44 cases of double number were the observation group treated with silibinincombined silybin combined with nucleoside(acid).The therapeutic effect after the end of the course of treatment were was evaluated.Results The effective rate in the observation group was 90.91％,which that in the control group was 70.45％,the difference was statistically significant (x2 =8.87,P ＜ 0.05).The ALT,AST,r-GGT after treatment of the observation group were (37.14 ± 3.56) U/L,(30.45 ±3.35) U/L,(51.65 ± 3.46) U/L,which were significantly reduced than before treatment(t =8.01,8.72,7.80,all P ＜ 0.05),and the differences were significant compared with the control group (t =7.57,8.34,7.29,all P ＜ 0.05).The TG,TC of blood lipid indexes indices after treatment of the observation group were (1.48 ±0.26) mmol/L,(5.18 ± 0.86)mmol/L,which were significantly lower than those before treatment (t =7.62,8.14,all P ＜ 0.05),and the differences were significant compared with the control group (t =7.10,7.55,all P ＜ 0.05).Conclusion The combination of silybin and nucleotides in the treatment of viral hepatitis with NAFLD has significant effect,can significantly improve the clinical symptoms and liver function indicators,and gradually restore the level of blood lipids,it is worthy of promoting the application.

Objective To evaluate premature clopidogrel cessation,intraoperative tranexamic acid and their interaction on bleeding and transfusion outcomes in on-pump CABG patients.Methods The current study is a prospective and randomized trial with 2 × 2 factorial design.The first factor is preoperative clopidogrel with 2 levels,clopidogrel ingestion within 7 days preoperatively (group E) and nave to clopidogrel (group B).The second level is antifibrinolytic therapy with 2 level,tranexamic acid (group T) and placebo (group P).A total of 333 patients receiving selective on-pump CABG were recruited.The tranexamic acid regimen was a bolus of 10 mg · kg-1 followed by a maintenance of 10 mg · kg 1 · h-1 throughout the surgery.Results Baseline characteristics were fairly balanced among the groups.Tranexamic acid significantly reduced postoperative blood loss.major bleeding,the volume of erythrocyte and plasma transfused,the exposure of erythrocyte,plasma and any allogeneic products (ET vs EP,P ＜ 0.01 ; BT vs BP,P ＜ 0.01).Clopidogrel within 7 days preoperatively significantly increased blood loss (EP vs BP,P＜0.05),major bleeding,the volume of erythrocyte (EP vs BP,P＜0.01) and the exposure of erythrocyte and plasma (EP vs BP,P ＜ 0.05) and any allogeneic products (EP vs BP,P ＜ 0.01).Under the protection of tranexamic acid,the bleeding and transfusion outcomes were comparable between the patients with premature clopidogrel cessation and those nave to clopidogrel (ET vs BP,P ＞0.05).Perioperative mortality,morbidity and the incidence of adverse events were comparable among the groups except for IABP.Conclusion Comparing with nave to clopidogrel,premature cessation within 7 days preoperatively deteriorated bleeding and transfusion outcomes in on-pump CABG patients.Intraoperative tianexamie acid could reduce the risk.

Objective To evaluate the blood-saving effect of tranexamic acid in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB).Methods The study was a prospective,randomized and placebo-control trial.Two hundred ASA Ⅰ-Ⅳ patients,aged 18-64 yr,weighing 50-100 kg,were randomized to receive placebo (group C,n =100) or tranexamic acid (group T,n =100).Tranexamic acid 10 mg/kg was intravenously infused over 20 min before skin incision followed by continuous infusion at 10 mg· kg-1 · h-1 until the end of operation in group T.While the equal volume of normal saline was given in group C.The total volume of postoperative chest tube drainage,postoperative massive bleeding and a second thoracotomy for stopping the bleeding were reordered.The requirement for transfusion of allogeneic blood and complications during the perioperative period were also recorded.Results Compared with group C,the total volume of postoperative chest tube drainage and incidences of postoperative massive bleeding and a second thoracotomy for stopping the bleeding were significantly decreased,and the requirement for transfusion of allogeneic red blood cells,platelet and fresh frozen plasma was reduced in group D (P ＜ 0.05).There was no significant difference in the incidence of complications between the two groups (P ＜ 0.05).Conclusion Tranexamic acid exerts the blood-saving effect in patients undergoing CABG with CPB and can significantly reduce postoperative bleeding and transfusion of allogeneic blood.