Objective To investigate the clinical effect of modified splenic artery embolization of the splenic artery and branch arteries in the treatment of splenic artery steal syndrome (SASS) and hypersplenism due to liver cirrhosis, since in patients with liver cirrhosis complicated by hypersplenism, the enlarged splenic artery competitively“steals”the blood flow in the celiac trunk and causes hypoperfusion in the hepatic artery (i.e., SASS due to liver cirrhosis) .Methods A total of 220 cirrhotic patients with hypersplenism and SASS who were hospitalized in General Hospital of the PLA Rocket Force and Chinese PLA General Hospital from January 2007 to December 2015 were enrolled and divided into medical treatment group with 120 patients (drugs combined with endoscopic intervention) , partial splenic embolization (PSE) with 40 patients (PSE combined with medical treatment) , and modified splenic artery embolization (MSAE) group with 60 patients (embolization of the splenic artery and branch arteries combined with medical treatment) .Related indices were analyzed and compared between the three groups.A one-way analysis of variance was used for comparison of continuous data between three groups, and the least significant difference t-test was used for further comparison between two groups;the chi-square test was used for comparison of categorical data between groups;the Kaplan-Meier survival analysis was used to calculate survival rates and gastrointestinal bleeding rate;the log-rank test was used to evaluate statistical difference.Results Within 5 years after surgery, the MSAE group had significantly higher platelet and leukocyte counts than the medical treatment group (P<0.05) .At 6 months after surgery, the MSAE group had a significantly lower Child-Pugh score than the medical treatment group (P<0.001) and the PSE group (P=0.014) ;at 1 year after surgery, the MSAE group still had a significantly lower Child-Pugh score than the medical treatment group (P=0.009) .At 6 months after surgery, the MSAE group had a significantly lower Model for End-Stage Liver Disease (MELD) score than the medical treatment group (P=0.004) and the PSE group (P=0.048) ;at 1 year after surgery, the MSAE group still had a significantly lower MELD score than the medical treatment group (P=0.012) .The MSAE group had significantly lower numbers of gastrointestinal bleeding/rebleeding events and endoscopic therapies than the PSE group (χ2=9.41, P=0.009) and the medical treatment group (χ2=10.91, P=0.004) ;at 5 years after surgery, the MSAE group still had a significantly lower incidence rate of gastrointestinal bleeding/rebleeding than the medical treatment group (χ2=14.70, P=0.002) .The MSAE group had certain improvements in the degree and duration of postoperative complications (pyrexia and abdominal pain) and had a lower incidence rate of serious complications (splenic abscess) , as compared with the other two groups.The median survival time was 45 (8-91) months in the MSAE group, 41 (6-86) months in the PSE group, and 34.5 (7-84) months in the medical treatment group.During the 5-year follow-up, 7 patients (11.7%) in the MSAE group, 40 (30%) in the medical treatment group, and 7 (17.5%) in the PSE group died.The MSAE group had a significantly higher cumulative survival rate than the medical treatment group (χ2=9.733, P=0.001) .Conclusion Modified splenic artery embolization of the splenic artery and branch arteries has good safety and can effectively correct hypersplenism and SASS due to liver cirrhosis, improve liver function, and reduce the risk of gastrointestinal bleeding.Therefore, it deserves further investigation.

Objective To investigate the clinical features of autoimmune liver disease (AILD) complicated by abdominal lymphadenectasis (LA) , as well as the clinical significance of LA in AILD.Methods A retrospective analysis was performed for the clinical data of 252 patients who were admitted to The First Affiliated Hospital of Dalian Medical University from January 2005 to April 2016, and among these patients, 52 had autoimmune hepatitis (AIH) , 174 had primary biliary cholangitis (PBC) , and 26 had AIH-PBC overlap syndrome (AIH-PBC OS) .A total of 78 patients underwent follow-up.According to the presence or absence of LA, these patients were divided into LA group with 70 patients and non-LA (NLA) group with 182 patients.As for general information, laboratory markers, imaging findings, and follow-up results, the normally distributed continuous data were expressed as mean±SD, and the t-test was used for comparison between groups;the non-normally distributed continuous data were expressed as median, and the Wilcoxon rank sum test was used for comparison between groups.The categorical data were expressed as rates, and the chi-square test, the corrected chi-square test, or the Fisher's exact test was used for comparison of these data between groups.Results There were no significant differences between the two groups in age, sex ratio, proportion of patients who were diagnosed due to abnormal liver function found by physical examination, and incidence rates of other autoimmune diseases.The incidence rate of abdominal LA was 22% (11/52) in the AIH group, 26.4% (46/174) in the PBC group, and50% (13/26) in the AIH-PBC OS group, and the AIH-PBC OS group had a significantly higher incidence rate than the AIH group and the PBC group (χ2=7.693, P=0.021) .The LA group had significantly higher levels of alkaline phosphatase and gamma-glutamyl transpeptidase (GGT) than the NLA group (Z=2.944 and 3.169, P=0.003 and 0.002) .For the patients with PBC, the LA group had a significantly higher level of GGT than the NLA group (Z=2.136, P=0.033) ;for the patients with AIH-PBC OS, the LA group had a significantly higher level of total bilirubin than the NLA group (Z=2.121, P=0.035) ;for the patients with AIH, there were no significant differences in these indices between the LA group and the NLA group.The LA group had a higher incidence rate of abnormal imaging findings than the NLA group (97.1% vs 81.9%, χ2=9.863, P=0.002) .A total of 78 patients were followed up with a median follow-up time of 18 months.Of all patients in the LA group, 6 (23.1%) achieved complete remission, 7 (26.9%) achieved incomplete response, 1 (3.8%) experienced recurrence, and 12 (46.2%) experienced treatment failure;of all patients in the NLA group, 21 (40.4%) achieved complete remission, 17 (32.7%) achieved incomplete response, 7 (13.5%) experienced recurrence, and 7 (13.5%) experienced treatment failure;there was a significant difference in the distribution of treatment outcomes between the LA group and the NLA group (Z=2.406, P=0.016) .Conclusion Patients with AIH-PBC OS have a higher incidence rate of abdominal LA than those with AIH and PBC, and patients with AILD complicated by LA may have marked cholestasis and liver impairment and poor treatment response, suggesting that LA might be used to determine disease severity and judge prognosis.

Objective To investigate the clinical and pathological features of autoimmune hepatitis (AIH) -primary biliary cholangitis (PBC) overlap syndrome (AIH-PBC OS) versus AIH, since it is still difficult to diagnose AIH-PBC OS in clinical practice, and to enhance the knowledge of AIH-PBC OS and improve its early diagnostic rate.Methods A prospective study was performed for the clinical data, biochemical and immunological markers, autoantibody, and liver pathology of 50 patients with AIH-PBC OS confirmed by liver biopsy who visited West China Hospital, Sichuan University, from January 20, 2015 to November 28, 2016 and 57 patients with AIH alone, in order to compare the features of AIH-PBC OS and AIH.Continuous data such as laboratory markers were expressed as median M (inter-quartile range) and the nonparametric rank sum test was used for comparison of these data between two groups;categorical data including clinical features、histopathological manifestations were expressed as rates and the chi-square test was used for comparison of these data between two groups.Results The AIH-PBC OS group had a significantly lower age of onset than the AIH group (Z=-1.975, P=0.048) , while there was no significant difference in male/female sex ratio between the two groups.The AIH-PBC OS group had a significantly higher proportion of patients with pruritus than the AIH group (22.0% vs 7.0%, χ2=4.960, P=0.026) .Compared with the AIH group, the AIH-PBC OS group had significantly higher levels of alkaline phosphatase (ALP) , gamma-glutamyl transpeptidase (GGT) , and immunoglobulin M (IgM) (Z=-6.250, -4.789, and-5.407, all P<0.001) , a significantly higher positive rate of antimitochondrial antibody (AMA) (χ2=26.811, P<0.001) , and significantly lower serum levels of alanine aminotransferase (ALT) , aspartate aminotransferase, and immunoglobulin G (IgG) (Z=-2.916, -3.381, and-2.285, P=0.004, 0.001, and 0.022) .The AIH-PBC OS group had significantly higher incidence rates of bile duct injury, bile duct loss, granulomatous disease, and cholestasis than the AIH group (χ2=25.612, 15.953, 6.490, and 10.042, P<0.001, <0.001, 0.001, and 0.002) .Conclusion Although AIH-PBC OS has the features of both AIH and PBC, it is not a simple overlap between AIH and PBC.Pruritus, significant increases in the levels of ALP, GGT, and IgM, positive AMA, and inflammatory bile duct disease and cholestasis may have implications for the diagnos of AIH-PBC OS.Since AIH-PBC OS may have milder liver inflammatory injury and autoimmune abnormalities than AIH, the levels of ALT and IgG in Paris criteria can be broadened during the diagnosis of AIH-PBC OS, in order to prevent missed diagnosis and avoid affecting the selection of treatment regimen and patients' prognosis.