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世界胃肠病学杂志(英文版)
世界胃肠病学杂志(英文版)

潘伯荣

周刊

1007-9327

wjg@wjgnet.com

010-85381901-628

100025

北京市朝阳区东四环中路62号楼远洋国际中心D座903室

世界胃肠病学杂志(英文版)/Journal World Journal of GastroenterologyCSCDCSTPCDSCI
查看更多>>主要报道和刊登国内外、特别是我国消化病学者具有创造性的、有较高学术水平的基础和临床研究论文、研究快报等. 对具有中国特色的研究论文, 如食管癌、胃癌、肝癌、大肠癌、病毒性肝炎、幽门螺杆菌、中医中药、中西医结合和基于作者自己研究工作为主的综述性论文, 将优先发表. 读者对象为基础研究或临床研究的消化专业工作者。
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    Patterns and prognosis of locally recurrent rectal cancer following multidisciplinary treatment

    Jun ZhaoChang-Zheng DuYing-Shi SunJin Gu...
    7015-7020页
    查看更多>>摘要:AIM:To investigate the patterns and decisive prognostic factors for local recurrence of rectal cancer treated with a multidisciplinary team (MDT) modality.METHODS:Ninety patients with local recurrence were studied,out of 1079 consecutive rectal cancer patients who underwent curative surgery from 1999 to 2007.For each patient,the recurrence pattern was assessed by specialist radiologists from the MDT using imaging,and the treatment strategy was decided after discussion by the MDT.The associations between clinicopathological factors and long-term outcomes were evaluated using both univariate and multivariate analysis.RESULTS:The recurrence pattern was classified as follows:Twenty-seven (30%) recurrent tumors were evaluated as axial type,21 (23.3%) were anterior type,8 (8.9%) were posterior type,and 13 (25.6%) were lateral type.Forty-one patients had tumors that were evaluated as resectable by the MDT and ultimately received surgery,and R0 resection was achieved in 36 (87.8%) of these patients.The recurrence pattern was closely associated with resectability and R0 resection rate (P < 0.001).The recurrence pattern,interval to recurrence,and RO resection were significantly associated with 5-year survival rate in univariate analysis.Multivariate analysis showed that the R0 resection was the unique independent factor affecting long-term survival.CONCLUSION:The MDT modality improves patient selection for surgery by enabling accurate classification of the recurrence pattern; RO resection is the most significant factor affecting long-term survival.

    Prealbumin is predictive for postoperative liver insufficiency in patients undergoing liver resection

    Liang HuangJing LiJian-Jun YanCai-Feng Liu...
    7021-7025页
    查看更多>>摘要:AIM:To investigate the risk factors for postoperative liver insufficiency in patients with Child-Pugh class A liver function undergoing liver resection.METHODS:A total of 427 consecutive patients undergoing partial hepatectomy from October 2007 to April 2011 at a single center (Department of Hepatic Surgery Ⅰ,Eastern Hepatobiliary Surgery Hospital,Shanghai,China) were included in the study.All the patients had preoperative liver function of Child-Pugh class A and were diagnosed as having primary liver cancer by postoperative histopathology.Surgery was performed by the same team and hepatic resection was carried out by a clamp crushing method.A clamp/unclamp time of 15 min/5 min was adopted for hepatic inflow occlusion.Patients' records of demographic variables,intraoperative parameters,pathological findings and laboratory test results were reviewed.Postoperative liver insufficiency and failure were defined as prolonged hyperbilirubinemia unrelated to biliary obstruction or leak,clinically apparent ascites,prolonged coagulopathy requiring frozen fresh plasma,and/or hepatic encephalopathy.The incidence of postoperative liver insufficiency or liver failure was observed and the attributing risk factors were analyzed.A multivariate analysis was conducted to determine the independent predictive factors.RESULTS:Among the 427 patients,there were 362 males and 65 females,with a mean age of 51.1 ±10.4 years.Most patients (86.4%) had a background of viral hepatitis and 234 (54.8%) patients had liver cirrhosis.Indications for partial hepatectomy included hepatocellular carcinoma (391 patients),intrahepatic cholangiocarcinoma (31 patients) and a combination of both (5 patients).Hepatic resections of ≤ 3 and ≥4 liver segments were performed in 358 (83.8%) and 69 (16.2%) patients,respectively.Seventeen (4.0%)patients developed liver insufficiency after hepatectomy,of whom 10 patients manifested as prolonged hyperbilirubinemia unrelated to biliary obstruction or leak,6 patients had clinically apparent ascites and prolonged coagulopathy,1 patient had hepatic encephalopathy and died on day 21 after surgery.On univariate analysis,age ≥ 60 years and prealbumin < 170mg/dL were found to be significantly correlated with postoperative liver insufficiency (P =0.045 and P =0.009,respectively).There was no statistical difference in postoperative liver insufficiency between patients with or without hepatitis,liver cirrhosis and esophagogastric varices.Intraoperative parameters (type of resection,inflow blood occlusion time,blood loss and blood transfusion) and laboratory test results were not associated with postoperative liver insufficiency either.Age ≥ 60 years and prealbumin < 170 mg/dL were selected on multivariate analysis,and only prealbumin < 170 mg/dL remained predictive (hazard ratio,3.192;95%CI:1.185-8.601,P =0.022).CONCLUSION:Prealbumin serum level is a predictive factor for postoperative liver insufficiency in patients with liver function of Child-Pugh class A undergoing hepatectomy.Since prealbumin is a good marker of nutritional status,the improved nutritional status may decrease the incidence of liver insufficiency.

    Contrast-enhanced ultrasonography assessment of gastric cancer response to neoadjuvant chemotherapy

    Jian AngLiang HuPin-Tong HuangJin-Xiu Wu...
    7026-7032页
    查看更多>>摘要:AIM:To quantitatively assess the ability of double contrast-enhanced ultrasound (DCUS) to detect tumor early response to pre-operative chemotherapy.METHODS:Forty-three patients with gastric cancer treated with neoadjuvant chemotherapy followed by curative resection between September 2011 and February 2012 were analyzed.Pre-operative chemotherapy regimens of fluorouracil + oxaliplatin or S-1 + oxaliplatin were administered in 2-4 cycles over 6-12 wk periods.All patients underwent contrast-enhanced computed tomography (CT) scan and DCUS before and after two courses of pre-operative chemotherapy.The therapeutic response was assessed by CT using the response evaluation criteria in solid tumors (RECIST 1.1) criteria.Tumor area was assessed by DCUS as enhanced appearance of gastric carcinoma due to tumor vascularity during the contrast phase as compared to the normal gastric wall.Histopathologic analysis was carried out according to the Mandard tumor regression grade criteria and used as the reference standard.Receiver operating characteristic (ROC) analysis was used to evaluate the efficacy of DCUS parameters in differentiating histopathological responders from non-responders.RESULTS:The study population consisted of 32 men and 11 women,with mean age of 59.7 ± 11.4 years.Neither age,sex,histologic type,tumor site,T stage,nor N stage was associated with pathological response.The responders had significantly smaller mean tumor size than the non-responders (15.7 ± 7.4 cm vs 33.3 ±14.1 cm,P < 0.01).According to Mandard's criteria,27patients were classified as responders,with 11 (40.7%)showing decreased tumor size by DCUS.In contrast,only three (18.8%) of the 16 non-responders showed decreased tumor size by DCUS (P < 0.01).The area under the ROC curve was 0.64,with a 95%CI of 0.46-0.81.The effects of several cut-off points on diagnostic parameters were calculated in the ROC curve analysis.By maximizing Youden's index (sensitivity +specificity-1),the best cut-off point for distinguishing responders from non-responders was determined,which had optimal sensitivity of 62.9% and specificity of 56.3%.Using this cut-off point,the positive and negative predictive values of DCUS for distinguishing responders from non-responders were 70.8% and 47.4%,respectively.The overall accuracy of DCUS for therapeutic response assessment was 60.5%,slightly higher than the 53.5% for CT response assessment with RECIST criteria (P =0.663).Although the advantage was not statistically significant,likely due to the small number of cases assessed.DCUS was able to identify decreased perfusion in responders who showed no morphological change by CT imaging,which can be occluded by such treatment effects as fibrosis and edema.CONCLUSION:DCUS may represent an innovative tool for more accurately predicting histopathological response to neoadjuvant chemotherapy before surgical resection in patients with locally-advanced gastric cancer.

    Major influence of renal function on hyperlipidemia after living donor liver transplantation

    Qi LingKai WangDi LuHai-Jun Guo...
    7033-7039页
    查看更多>>摘要:AIM:To investigate the impact of renal and graft function on post-transplant hyperlipidemia (PTHL) in living donor liver transplantation (LDLT).METHODS:A total of 115 adult patients undergoing LDLT from January 2007 to May 2009 at a single center were enrolled.Data were collected and analyzed by the China Liver Transplant Registry retrospectively.PTHL was defined as serum triglycerides ≥ 150 mg/dL or serum cholesterol ≥ 200 mg/dL or the need for pharmacologic treatment at the sixth month after LDLT.Early renal dysfunction (ERD) was defined as serum creatinine ≥ 2 mg/dL and/or the need for renal replacement therapy in the first post-transplant week.RESULTS:In 115 eligible patients,the incidence of PTHL was 24.3%.Recipients with PTHL showed a higher incidence of post-transplant cardiovascular events compared to those without PTHL (17.9% vs 4.6%,P=0.037).Serum creatinine showed significant positive correlations with total serum triglycerides,both at posttransplant month 1 and 3 (P < 0.01).Patients with ERD had much higher pre-transplant serum creatinine levels (P < 0.001) and longer duration of pre-transplant renal insufficiency (P < 0.001) than those without ERD.Pretransplant serum creatinine,graft-to-recipient weight ratio,graft volume/standard liver volume ratio,body mass index (BMI) and ERD were identified as risk factors for PTHL by univariate analysis.Furthermore,ERD [odds ratio (OR) =9.593,P < 0.001] and BMI (OR =6.358,P =0.002) were identified as independent risk factors for PTHL by multivariate analysis.CONCLUSION:Renal function is closely associated with the development of PTHL in LDLT.Post-transplant renal dysfunction,which mainly results from pre-transplant renal insufficiency,contributes to PTHL.

    Effect of salvianolate on intestinal epithelium tight junction protein zonula occludens protein 1 in cirrhotic rats

    Dan-Hong YangZai-Yuan YeYuan-Jun XieXu-Jun He...
    7040-7047页
    查看更多>>摘要:AIM:To study the effect of salvianolate on tight junctions (TJs) and zonula occludens protein 1 (ZO-1) in small intestinal mucosa of cirrhotic rats.METHODS:Cirrhosis was induced using carbon tetrachloride.Rats were randomly divided into the untreated group,low-dose salvianolate (12 mg/kg) treatment group,medium-dose salvianolate (24 mg/kg) treatment group,and high-dose salvianolate (48 mg/kg) treatment group,and were treated for 2 wk.Another 10 healthy rats served as the normal control group.Histological changes in liver tissue samples were observed under a light microscope.We evaluated morphologic indices of ileal mucosa including intestinal villi width and thickness of mucosa and intestinal wall using a pathological image analysis system.Ultrastructural changes in small intestinal mucosa were investigated in the five groups using transmission electron microscopy.The changes in ZO-1 expression,a tight junction protein,were analyzed by immunocytochemistry.The staining index was calculated as the product of the staining intensity score and the proportion of positive cells.RESULTS:In the untreated group,hepatocytes showed a disordered arrangement,fatty degeneration was extensive,swelling was obvious,and disorganized lobules were divided by collagen fibers in hepatic tissue,which were partly improved in the salvianolate treated groups.In the untreated group,abundant lymphocytes infiltrated the fibrous tissue with proliferation of bile ducts,and collagen fibers gradually decreased and damaged hepatic lobules were partly repaired following salvianolate treatment.Compared with the untreated group,no differences in intestinal villi width between the five groups were observed.The villi height as well as mucosa and intestinal wall thickness gradually thickened with salvianolate treatment and were significantly shorter in the untreated group compared with those in the salvianolate treatment groups and normal group (P < 0.01).The number of microvilli decreased and showed irregular lengths and arrangements in the untreated group.The intercellular space between epithelial cells was wider.The TJs were discontinuous,which indicated disruption in TJ morphology in the untreated group.In the treated groups,the microvilli in the intestinal epithelium were regular and the TJs were gradually integrated and distinct.The expression of ZO-1 decreased in the small intestine of the untreated cirrhotic rats.The high expression rate of ZO-1 in ileal mucosa in the untreated group was significantly lower than that in the medium-dose salvianolate group (21.43% vs 64.29%,x2 =5.25,P < 0.05),high-dose salvianolate group (21.43% vs 76.92%,x2 =8.315,P < 0.01) and normal group (21.43% vs 90%,x2 =10.98,P < 0.01).CONCLUSION:Salvianolate improves liver histopathological changes,repairs intestinal mucosa and TJ structure,and enhances ZO-1 expression in the small intestinal mucosa in cirrhotic rats.

    Hepatic focal nodular hyperplasia in children: Imaging features on multi-slice computed tomography

    Qing-Yu LiuWei-Dong ZhangDong-Ming LaiYing Ou-yang...
    7048-7055页
    查看更多>>摘要:AIM:To retrospectively analyze the imaging features of hepatic focal nodular hyperplasia (FNH) in children on dynamic contrast-enhanced multi-slice computed tomography (MSCT) and computed tomography angiography (CTA) images.METHODS:From September 1999 to April 2012,a total of 218 cases of hepatic FNH were confirmed by either surgical resection or biopsy in the Sun Yat-sen Memorial Hospital of Sun Yat-sen University and the Cancer center of Sun Yat-sen University,including 12 cases (5.5%) of FNH in children (age ≤ 18 years old).All the 12 pediatric patients underwent MSCT.We retrospectively analyzed the imaging features of FNH lesions,including the number,location,size,margin,density of FNH demonstrated on pre-contrast and contrastenhanced computed tomography (CT) scanning,central scar,fibrous sepia,pseudocapsule,the morphology of the feeding arteries and the presence of draining vessels (portal vein or hepatic vein).RESULTS:All the 12 pediatric cases of FNH had solitary lesion.The maximum diameter of the lesions was 4.0-12.9 cm,with an average diameter of 5.5 ± 2.5 cm.The majority of the FNH lesions (10/12,83.3%) had well-defined margins.Central scar (10/12,83.3%) and fibrous septa (11/12,91.7%) were commonly found in children with FNH.Central scar was either isodense (n =7) or hypodense (n =3) on pre-contrast CT images and showed progressive enhancement in 8 cases in the equilibrium phase.Fibrous septa were linear hypodense areas in the arterial phase and isodense in the portal and equilibrium phases.Pseudocapsule was very rare (1/12,8.3%) in pediatric FNH.With the exception of central scars and fibrous septa within the lesions,all 12 cases of pediatric FNH were homogenously enhanced on the contrast-enhanced CT images,significantly hyperdense in the arterial phase (12/12,100.0%),and isodense in the portal venous phase (7/12,58.3%) and equilibrium phase (11/12,91.7%).Central feeding arteries inside the tumors were observed on CTA images for all 12 cases of FNH,whereas no neovascularization of malignant tumors was noted.In 9 cases (75.0%),there was a spoke-wheel shaped centrifugal blood supply inside the tumors.The draining hepatic vein was detected in 8 cases of pediatric FNH.However,the draining vessels in the other 4 cases could not be detected.No associated hepatic adenoma or hemangioma was observed in the livers of the 12 pediatric cases.CONCLUSION:The characteristic imaging appearances of MSCT and CTA may reflect the pathological and hemodynamic features of pediatric FNH.Dynamic multi-phase MSCT and CTA imaging is an effective method for diagnosing FNH in children.

    Radical treatment of stage Ⅳ pancreatic cancer by the combination of cryosurgery and iodine-125 seed implantation

    Ji-Bing ChenJia-Liang LiLi-Hua HeWei-Qun Liu...
    7056-7062页
    查看更多>>摘要:AIM:To investigate the therapeutic effect of radical treatment and palliative treatment in stage Ⅳ pancreatic cancer patients.METHODS:81 patients were enrolled in the study.Radical treatment was performed on 51 patients,while 30 patients were put under palliative treatment.The procedural safety and interval survival for stage Ⅳ pancreatic cancer (IS-Ⅳ) was assessed by almost 2.5 years of follow-ups.The IS-Ⅳ of patients under the two kinds of treatment,and the effects of treatment timing and frequency on IS-Ⅳ,were compared.RESULTS:The IS-Ⅳ of patients who received radical treatment was significantly longer than those who received palliative treatment (P < 0.001).The IS-Ⅳ of patients who received delayed radical or palliative treatment was longer than those who received accordingly timely treatment (P =0.0034 and 0.0415,respectively).Multiple treatments can play an important role in improving the IS-Ⅳ of patients who received radical treatment (P =0.0389),but not for those who received palliative treatment (P =0.99).CONCLUSION:The effect of radical treatment was significantly more obvious than that of palliative treatment,and multiple radical treatments may contribute more to patients than a single radical treatment.

    Protective role of metalloproteinase inhibitor (AE-941) on ulcerative colitis in rats

    Jing-Wei MaoXiao-Mei HeHai-Ying TangYing-De Wang...
    7063-7069页
    查看更多>>摘要:AIM:To evaluate the protective role of AE-941,a matrix metalloproteinase (MMP) inhibitor,on ulcerative colitis (UC) in rats.METHODS:Sprague Dawley (SD) rats were randomly divided into three groups:a control group,an AE-941treatment group,and an UC model group.Rats were sacrificed on days 7,21,or 56 following administration of treatment by enema and the disease activity index (DAI),colonic mucosa damage index (CMDI) and colonic expression of MMP-2 and MMP-9 were assessed.RESULTS:DAI and CDMI scores in the UC model group increased significantly compared to the control group at all timepoints (P < 0.001),and also increased significantly at the 21-and 56-d timepoints compared to the AE-941-treated group (DAI:21-and 56-d =2.09 ± 0.25,1.52 ± 0.30 vs 1.55 ± 0.28,0.59 ± 0.19,respectively,P =0.040 and 0.007,CMDI:21-and 56-d =3.03 ± 0.42,1.60 ± 0.35 vs 2.08 ± 0.46,0.86 ±0.37,respectively,P =0.040 and 0.005).Furthermore,the colonic expression of MMP-2 and MMP-9 in the UC model group increased significantly compared to the control group (P < 0.001),and also increased compared to the AE-941-treated group on the 21-and 56-d timepoints (MMP-2:21-and 56-d =0.6048 ± 0.0522,0.4163 ± 0.0330 vs 0.3983 ± 0.0218,0.1093 ± 0.0072,respectively,P =0.010; MMP-9:21-and 56-d =0.6873 ± 0.0472,0.4328 ± 0.0257 vs 0.5179 ± 0.0305,0.2673± 0.0210,respectively,P =0.010 and 0.040).CONCLUSION:Expression of MMP-2 and MMP-9 increased significantly in rats with UC.AE-941 can reduce colonic mucosal damage by downregulating the expression of MMP-2 and MMP-9.

    Connective tissue growth factor is overexpressed in human hepatocellular carcinoma and promotes cell invasion and growth

    Ming XiuYa-Hui LiuDavid R BrigstockFang-Hui He...
    7070-7078页
    查看更多>>摘要:AIM:To determine the expression characteristics of connective tissue growth factor (CTGF/CCN2) in human hepatocellular carcinoma (HCC) in histology and to elucidate the roles of CCN2 on hepatoma cell cycle progression and metastasis in vitro.METHODS:Liver samples from 36 patients (who underwent hepatic resection for the first HCC between 2006 and 2011) and 6 normal individuals were examined for transforming growth factor β1 (TGF-β1) or CCN2 mRNA by in situ hybridization.Computer image analysis was performed to measure integrated optimal density of CCN2 mRNA-positive cells in carcinoma foci and the surrounding stroma.Fibroblast-specific protein-1 (FSP-1) and E-cadherin were examined to evaluate the process of epithelial to mesenchymal transition,α-smooth muscle actin and FSP-1 were detected to identify hepatic stellate cells,and CD34 was measured to evaluate the extent of vascularization in liver tissues by immunohistochemical staining.CCN2 was assessed for its stimulation of HepG2 cell migration and invasion using commercial kits while flow cytometry was used to determine CCN2 effects on HepG2 cell-cycle.RESULTS:In situ hybridization analysis showed that TGF-β1 mRNA was mainly detected in connective tissues and vasculature around carcinoma foci.In comparison to normal controls,CCN2 mRNA was enhanced 1.9-fold in carcinoma foci (12.36 ± 6.08 vs 6.42 ± 2.35)or 9.4-fold in the surrounding stroma (60.27 ± 28.71 vs 6.42 ± 2.35),with concomitant expression of CCN2 and TGF-β1 mRNA in those areas.Epithelial-mesenchymal transition phenotype related with CCN2 was detected in 12/36 (33.3%) of HCC liver samples at the edges between carcinoma foci and vasculature.Incubation of HepG2 cells with CCN2 (100 ng/mL) resulted in more of the cells transitioning into S phase (23.85 ± 2.35vs 10.94 ± 0.23),and induced a significant migratory (4.0-fold) and invasive (5.7-fold) effect.TGF-β1-induced cell invasion was abrogated by a neutralizing CCN2 antibody showing that CCN2 is a downstream mediator of TGF-β1-induced hepatoma cell invasion.CONCLUSION:These data support a role for CCN2 in the growth and metastasis of HCC and highlight CCN2 as a potential novel therapeutic target.

    Astragalus polysaccharides can regulate cytokine and P-glycoprotein expression in H22 tumor-bearing mice

    Qing-E TianHuan-De LiMiao YanHua-Lin Cai...
    7079-7086页
    查看更多>>摘要:AIM:To investigate the adjunct anticancer effect of Astragalus polysaccharides in H22 tumor-bearing mice.METHODS:To establish a solid tumor model,5.0 ×106/mL H22 hepatoma cells were inoculated subcutaneously into the right armpit region of Kunming mice (6-12wk old,18-22 g).When the tumors reached a size of 100 mm3,the animals were treated as indicated,and the mice were randomly assigned to seven groups (n=10 each).After ten days of treatment,blood samples were collected from mouse eyes,and serum was harvested by centrifugation.Mice were sacrificed,and the whole body,tumor,spleen and thymus were weighed immediately.The rate of tumor inhibition and organ indexes were calculated.The expression levels of serum cytokines,P-glycoprotein (P-GP) and multidrug resistance (MDR) 1 mRNA in tumor tissues were detected using enzyme-linked immunosorbent assay,Western blotting,and quantitative myeloid-derived suppressor cells reverse transcription-polymerase chain reaction,respectively.RESULTS:The tumor inhibition rates in the treatment groups of Adriamycin (ADM) + Astragalus polysaccharides (APS) (50 mg/kg),ADM + APS (100 mg/kg),and ADM + APS (200 mg/kg) were significantly higher than in the ADM group (72.88% vs 60.36%,P =0.013;73.40% vs 60.36%,P =0.010; 77.57% vs 60.36%,P =0.001).The spleen indexes of the above groups were also significantly higher than in the ADM group (0.65 ± 0.22 vs 0.39 ± 0.17,P =0.023; 0.62 ± 0.34 vs0.39 ± 0.17,P =0.022; 0.67 ± 0.20 vs 0.39 ± 0.17,P=0.012),and the thymus indexes of the ADM + APS (100 mg/kg) and ADM + APS (200 mg/kg) groups were significantly higher than in the ADM group (0.20 ± 0.06vs 0.13 ±-0.04,P =0.029; 0.47 ± 0.12 vs 0.13 ± 0.04,P =0.000).APS was found to exert a synergistic antitumor effect with ADM and to alleviate the decrease in the sizes of the spleen and thymus induced by AMD.The expression of interleukin-1α (IL-1α),IL-2,IL-6,and tumor necrosis factor-α (TNF-α) was significantly higher in the ADM + APS (50 mg/kg),ADM + APS (100mg/kg) and ADM + APS (200 mg/kg) groups than in the ADM group; and IL-10 was significantly lower in the above groups than in the ADM group.APS could increase IL-1α,IL-2,IL-6,and TNF-α expression and decrease IL-10 levels.Compared with the ADM group,APS treatment at a dose of 50-200 mg/kg could downregulate MDR1 mRNA expression in a dose-dependent manner (0.48 ± 0.13 vs 4.26 ± 1.51,P =0.000; 0.36± 0.03 vs 4.26 ± 1.51,P =0.000; 0.21 ± 0.04 vs4.26 ± 1.51,P =0.000).The expression level of P-GP was significantly lower in the ADM + APS (200 mg/kg)group than in the ADM group (137.35 ± 9.20 mg/kg vs 282.19 ± 20.54 mg/kg,P =0.023).CONCLUSION:APS exerts a synergistic anti-tumor effect with ADM in H22 tumor-bearing mice.This may be related to its ability to enhance the expression of IL-1α,IL-2,IL-6,and TNF-α,decrease IL-10,and downregulate MDR1 mRNA and P-GP expression levels.