国际规范大型多中心麝香保心丸随机双盲安慰剂对照研究揭盲——专家共议中西医结合的冠心病治疗之路

2017-09-12 佚名 中国中医药网

近日,由中国中西医结合学会心血管病专业委员会主办的第十五次全国中西医结合心血管学术会议暨福建省中西医结合学会心血管病学分会学术年会在福州召开。国医大师陈可冀院士、复旦大学附属中山医院葛均波院士等心血管病权威专家出席会议并围绕冠心病的中西医结合防治研究做了主题报告。

近日,由中国中西医结合学会心血管病专业委员会主办的第十五次全国中西医结合心血管学术会议暨福建省中西医结合学会心血管病学分会学术年会在福州召开。国医大师陈可冀院士、复旦大学附属中山医院葛均波院士等心血管病权威专家出席会议并围绕冠心病的中西医结合防治研究做了主题报告。会上发布了《麝香保心丸治疗冠心病中国专家共识》,研究显示,麝香保心丸可显着改善冠心病患者血管内皮功能,促进血管新生,长期使用可明显促进冠脉狭窄患者侧支循环建立,从而改善患者冠脉微循环障碍。

1.《麝香保心丸治疗冠心病中国专家共识》发布

可显着改善冠心病患者血管内皮功能

麝香保心丸作为我国具有独立知识产权的心血管治疗药物,应用于临床已有近40年,主要用于缓解心绞痛症状。近期揭盲的大型多中心麝香保心丸随机、双盲、安慰剂对照研究,评价了长期服用麝香保心丸对于预防心绞痛发作和临床事件的影响,为中西医结合治疗冠心病提供了新的临床证据。

本次会议上,葛均波院士发表题为《从远古走向现代的心血管内科发展历程》的学术报告,对心血管内科发展的各个时期的经典诊疗方法、治疗手段等进行梳理,展示了中国心血管内科的发展历程。复旦大学附属华山医院范维琥教授就冠心病稳定性心绞痛(胸痹心痛)的治疗,第二军医大学附属长征医院吴宗贵教授就中成药在冠心病治疗中的合理应用相关话题分别发表演讲。范维琥教授指出,我国有着数千年的治疗胸痹心痛的经验,我们应继承这些经验,同时借鉴现代医学,走一条结合医学之路。吴宗贵教授则站在西医的角度,对冠心病中成药的合理应用提供了建议,并指出,麝香保心丸是较为经典的芳香温通类药物,疗效已先后得到多项临床研究验证。


▲上海和黄药业出席领导为“和黄杯”优秀论文作者颁奖。


▲陈可冀院士为“和黄杯”一等奖论文作者颁奖。

河南中医学院第一附属医院朱明军教授主持了“和黄杯”论文评选大赛获奖论文的颁奖仪式。陈可冀院士、和黄药业负责人等为“和黄杯”获奖论文作者颁奖。

在冠心病中西医结合防治研究专题会环节,第二军医大学柳润辉教授主要介绍了系统生物学在中医药现代化研究中的应用。她指出,多靶点治疗是生物医学未来的发展方向,也是中药整体作用的特点和优势所在。利用系统生物学和分子生物网络阐明中药的多靶点作用可助力中药现代化研究。

复旦大学附属华山医院施海明教授对《麝香保心丸治疗冠心病中国专家共识》(下简称《共识》)进行了解读,他指出,麝香保心丸作为芳香温通类药物,是心血管疾病治疗的经典中成药,并对该共识中麝香保心丸在长期治疗稳定性冠心病、老年冠心病、冠心病合并心力衰竭和心律失常、经皮冠状动脉介入治疗(PCI)术后患者的联合应用、冠心病合并糖尿病、冠脉微血管病变方面的循证证据进行了梳理,使与会者对麝香保心丸治疗冠心病的疗效和安全性有了更系统的认识。

第二军医大学附属长征医院梁春教授发表了关于冠脉微循环障碍的报告。他指出,冠脉微血管病所涉及的患者群十分广泛,临床中以改善患者症状、延长生存、减少不良事件发生率作为评估标准,目的是改善心肌需氧/供氧矛盾,预防心室重构。冠脉微循环障碍在中医中属心络受损、血瘀络阻、络脉绌急。研究显示,麝香保心丸可显着改善冠心病患者血管内皮功能,促进血管新生,长期使用可明显促进冠脉狭窄患者侧支循环建立,从而改善患者冠脉微循环障碍。他指出,尽管已取得一定进展,但微循环障碍的治疗相关研究仍需进一步探索,尤其在改善主要不良事件终点(如死亡和心梗)方面。

2.专家访谈

01. 柳润辉教授:中医药整体观治疗理念与系统生物学思想不谋而合


▲柳润辉 现任第二军医大学药学院天然药化教研室副教授、硕士研究生导师,福建中医学院兼职硕导

Q1:中药复方制剂具有多靶点、多作用途径的特点,阐明其具体作用机制仍是一个巨大挑战,目前在中医药现代化研究方面取得了哪些进展?

柳润辉教授:中医药是我国传统文化的瑰宝,而中药复方是中药临床用药的主要形式。与西药不同的是,中药是源于经验,而后用于临床,最后才回归于实验室。中药复方是在中医理论“君、臣、佐、使”的指导原则下组成的含有多个药味、多种化学成分的复方制剂,因此作用机制非常复杂。当前西药的研究方式难以阐述中药复方的作用靶点和作用机制。但随着现代科学技术的发展,中药复方的现代研究也有了更多的支撑,中药现代研究也是中医药走出国门的必须。我国开展中医药现代研究30年来,取得了很多骄人成绩,主要涵盖揭示了中医药理论的科学内涵、阐述了中药复方配伍的科学性合理性、从传统中药中开发中药新药等几大方面。

Q2:系统生物学方法在中药研究中如何应用?

柳润辉教授:系统生物学方法最早应用于西药研究。当时研究者发现,由于人体是一个复杂系统,疾病的发生多为多因素作用的结果,因此单纯针对某个靶点的治疗药物,其效果往往并不令人满意,由此就诞生了系统生物学的概念。而我们的中药化学成分多样而复杂,有多靶点的作用特点,其整体观治疗理念与系统生物学思想不谋而合,因此我们将系统生物学方法引入中医药研究。目前系统生物学方法在中医药领域取得了2大成就:一是对现有中医理论进行了系统性阐述与探索;二是解释了中药复方在体内的整体调控机制,包括从代谢水平、基因水平、蛋白调控水平等。

Q3:通过系统生物学方法研究麝香保心丸治疗心绞痛的作用机制目前取得了哪些进展?下一步研究的方向是什么?

柳润辉教授:我们课题组15年来始终致力于中药复方现代化研究,而麝香保心丸一直是我们研究的重点。研究显示,在代谢组学方面,麝香保心丸有抗炎、改善心肌肥大、改善异常能量代谢、改善血小板的作用,能有效治疗冠心病和心肌梗死;在基因组学方面,麝香保心丸能有效恢复心肌收缩力、抑制心肌纤维化;在网络药理学水平,我们探索了麝香保心丸的网络调控机理;另外,我们还从基因芯片、分子生物学水平验证了上述结果的合理性。后期我们还将开展麝香保心丸的转化医学研究,并试图将前期的实验室数据应用于临床。

02. 吴宗贵教授:大型临床研究是中医药走向国际、被现代医学接受的必然途径


▲吴宗贵 上海长征医院心血管内科主任医师

Q1:请您介绍一下麝香保心丸临床应用经验。

吴宗贵教授:麝香保心丸是一款经典的心血管治疗药物,上世纪70~80年代由华山医院戴瑞鸿教授成功研制。在上世纪90年代,麝香保心丸是上海家喻户晓的急救药物。这些年来,麝香保心丸在全国享有越来越高的知名度,这足以说明它的临床疗效。

麝香保心丸君药为麝香,方中大多是芳香温通类药物。这些药物成分对于解除血管痉挛、减少血栓有着独特疗效,因此对于临床上症状性心绞痛,特别是在胸痛、胸闷发作时使用缓解效果明显。

Q2:《麝香保心丸治疗冠心病中国专家共识》制定的背景和意义是什么?

吴宗贵教授:众所周知,同一类西药的作用靶点、作用机制是类似的,针对同一类西药的专家共识可以对临床起到良好的指导作用。而中药复方与西药不同,中药复方是按照中医“君、臣、佐、使”理念组成的方剂,因此在临床上几乎没有成分完全相同的两种中药。另外,中药有着多靶点、多途径的作用特点,治疗上更讲究整体观,不同专家积累的临床经验也会有差异。因此相对于西药,中药更需要有相应的专家共识指导临床实践。

Q3:该部共识对麝香保心丸大型随机双盲对照多中心研究提供的指导意见有哪些?

吴宗贵教授:大型临床研究是祖国中医药走向国际、被现代医学接受的必然途径。在中药专家共识的基础之上,结合一些大型临床研究证据,运用现代医学手段证明中药的疗效与安全性将更有说服力,也能让更多西医接受中药,使其在中西医结合的治疗中发挥更好的作用。与西药类似,未来中药的临床应用也将走指南之路,然而目前中药相关指南还比较少。相信目前发布的中药共识、开展的大型中药研究将对中药指南的制定提供一定的参考和借鉴。

03. 施海明教授:长期服用麝香保心丸能减少心绞痛和临床事件发生


▲施海明 现任复旦大学附属华山医院心内科主任,大内科主任,主任医师,博士研究生导师

Q1:请您介绍一下麝香保心丸目前在临床的应用情况。

施海明教授:麝香保心丸源自古方苏合香丸,于1981年进入临床,是最早上市的芳香温通类中成药,主要用于急性心梗的急救。临床应用40年来,麝香保心丸在芳香温通类冠心病治疗药物里,市场占有率排名全国第一,可见其临床疗效和安全性已广为医生、患者认可和接受。麝香保心丸最早由华山医院戴瑞鸿教授成功研制,早年在上海是家喻户晓的急救药物。在和黄药业现代市场理念的打造下,自2000年起,麝香保心丸开始逐渐被长江三角乃至全国的医生患者所接受。

Q2:除临床经验外,制定《麝香保心丸治疗冠心病中国专家共识》还参考了哪些基础研究及临床研究?

施海明教授:华山医院是该部《共识》的主要起草单位。这不仅是因为麝香保心丸诞生于华山医院,华山医院有20~30年的临床用药经验,而且华山医院一直以来也在积极开展与麝香保心丸相关的各项基础研究和临床研究。我们起草该共识的初衷主要有两点:首先,随着工业化进程,人类的疾病谱发生了较大改变,高血压糖尿病、心脑血管疾病等非传染性炎症性疾病已经占主导地位。面对西医不够令人满意的治疗现状,我们思考祖国传统中医药的整体治疗观,多因素、多机制的治疗特点能否力挽狂澜。其二,麝香保心丸有着40年临床用药经验的积累,期间发表的文章达2000多篇。从中我们筛选价值含量较高的文章200多篇,在此基础上进行归纳总结,以期对麝香保心丸的用药经验进行提炼,帮助临床医生合理用药。

Q3:刚刚揭盲的麝香保心丸研究将对未来中国指南有何影响?

施海明教授:麝香保心丸虽有近40年用药经验,但现有临床研究均是小样本观察性研究。麝香保心丸虽是缓解心绞痛的急救药物,早期动物实验发现,长期使用麝香保心丸有血管保护作用。临床观察也证实了这一点,长期应用麝香保心丸3个月,患者血管内皮有改善;使用6个月后,血管内皮明显改善,且心肌梗死区出现放射性核素填充,提示有血管新生。我院一项早期观察性研究发现,长期服用麝香保心丸与对照组相比,心绞痛、再次住院、再次急诊的发生率明显降低。基于此发现,2009年我们设计了麝香保心丸大规模观察性研究。研究采用随机双盲安慰剂对照的严格设计,以期最大程度地降低主观误差的影响。2011年研究正式启动,2015年完成随访,近期揭盲。目前来看,研究结果与预期设想完全一致,即长期服用麝香保心丸能减少心绞痛和临床事件发生,提高了患者生活质量。

04. 范维琥教授:麝香保心丸大型多中心研究结果将对后续指南制定有积极影响


▲范维琥 现任复旦大学附属华山医院心内科教授,博士生导师

Q1:请您介绍一下麝香保心丸大型多中心研究的背景及设计情况。

范维琥教授:阿司匹林、他汀、硝酸酯类、β受体阻滞剂、钙离子通道阻滞剂等是当前慢性稳定性冠心病患者标准的治疗方案。然而临床上不少患者在经规范治疗后仍有心绞痛发生。麝香保心丸是我国中药文化的瑰宝,长久以来作为心绞痛急救药物。对于有治疗需求,但未获得满意治疗的稳定性冠心病患者,在标准治疗基础上加用麝香保心丸能否优化治疗效果,能否进一步减少心绞痛发作,预防或减少心肌梗死或死亡发生,是我们设计麝香保心丸大型多中心研究的初衷。

全国共有100家中心参与了这项研究。为了消除主观偏倚的影响,研究采用严谨的随机、双盲、安慰剂对照的设计,而安慰剂对照的研究设计实属国内中成药首创。所有受试者入组后服用麝香保心丸长达2年。目前该研究已揭盲,数据也正在整理当中。

Q2:该项研究结果对临床实践有何影响?

范维琥教授:麝香保心丸大型多中心研究评价了麝香保心丸的长期有效性和安全性。结果显示,稳定性冠心病患者长期使用麝香保心丸能有效改善冠心病症状,减少心绞痛发生。对于终点事件的影响还有待后续分析结果的揭晓。考虑到稳定性冠心病本身终点事件的发生率有限,当前研究的样本量或许还不足以体现临床硬终点的差别。需强调的是,中药复方基于“君、臣、佐、使”的原理设计而成,药味分工合理,作用协同,因此不能简单拿西药的循证标准评判中药。麝香保心丸大型多中心研究不但充实了中西医结合治疗冠心病的临床证据,还推动了我国中西医结合的研究进展。相信在新证据的支持下,拥有临床证据的中成药的使用范围将得以扩大。

Q3:该项研究结果会对后续相关指南的制定有何影响?

范维琥教授:我们要重视指南,但也不能唯指南论,应以辩证的眼光看待指南,因为患者的治疗离不开个体化。避免劳累、中西医药物治疗、介入、搭桥等都是冠心病治疗的重要手段。然而当下并没有一部指南将中医、西医的力量有机结合,不是缺此就是失彼。相信麝香保心丸大型多中心研究结果将对后续指南的制定有着积极影响。

05. 陈可冀院士:麝香保心丸是中医药“传承、创新、发展”的良好示范


▲陈可冀 中国科学院院士、国医大师

Q1:目前中医药在冠心病治疗中的地位和作用如何?如何看待中西医结合治疗冠心病这一治疗模式?

陈可冀院士:虽然在现代医学中,西医在冠心病的治疗中仍占主导,中药似乎处于辅助地位,但这也并不是绝对的。比如有的心绞痛患者不耐受硝酸甘油,换用麝香保心丸后治疗反应良好。介入、搭桥等西医手段治疗冠心病虽有一定效果,但冠心病患者需要全程关怀。在疾病的预防阶段、在患者出现的精神心理障碍或躯体症状时,中药有着独特的治疗作用。因此对于各类型的冠心病患者,最好采用中西医结合的治疗模式,这有利于发挥两者的优势互补作用。

Q2:《麝香保心丸治疗冠心病中国专家共识》的发布、循证结果的即将公布,您觉得对临床会带来怎样的影响?对未来相关指南的制定有何意义?

陈可冀院士:麝香保心丸在我国有着悠久的历史。系列研究也证实,麝香保心丸有抗炎、改善内皮、促血管生成的综合作用,对心肌梗死、心肌缺血治疗有效。《共识》的发布以及麝香保心丸大型循证研究将让更多的临床医生有用药信心,扩大药物的使用范围,使更多冠心病患者从中获益,同时也将促进相关心血管指南的制定。

Q3:对于中医药的发展方向,您有什么建议或期许?

陈可冀院士:中医药的发展应走“传承、创新、发展”的科学道路。中医药在传承传统理念的同时,还应在创新中求发展,用现代科学研究方法阐明中医药的作用机理。麝香保心丸就是“传承、创新、发展”的良好示范。以往中医药更注重专家经验,而西药比较重视循证,其实经验与证据两者都是不可或缺的

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    2018-07-20 amyloid
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href='/topic/show?id=04514581178' target=_blank style='color:#2F92EE;'>#安慰剂对照#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45811, encryptionId=04514581178, topicName=安慰剂对照)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9b4217235139, createdName=guoyibin, createdTime=Thu Sep 14 14:32:00 CST 2017, time=2017-09-14, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1775340, encodeId=8d991e75340fb, content=<a href='/topic/show?id=937d46650bf' target=_blank style='color:#2F92EE;'>#对照#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46650, encryptionId=937d46650bf, topicName=对照)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8ae138776909, createdName=amyloid, createdTime=Fri Jul 20 06:32:00 CST 2018, time=2018-07-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1903928, encodeId=d06b19039286e, content=<a href='/topic/show?id=7d454302945' target=_blank style='color:#2F92EE;'>#多中心#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43029, encryptionId=7d454302945, topicName=多中心)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=02f5179, 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createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/07/20/71f2c82f2515186c4d565a27af9ac6f3.jpg, createdBy=84562001987, createdName=午后阳光, createdTime=Thu Sep 14 16:43:57 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1304341, encodeId=fb7a1304341db, content=<a href='/topic/show?id=81724580886' target=_blank style='color:#2F92EE;'>#安慰剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45808, encryptionId=81724580886, topicName=安慰剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4cce318, createdName=wleon8895, createdTime=Thu Sep 14 14:32:00 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1463024, encodeId=0de01463024a2, content=<a href='/topic/show?id=83312253524' target=_blank style='color:#2F92EE;'>#中西医#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22535, encryptionId=83312253524, topicName=中西医)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=693f6527574, createdName=lizhou0206, createdTime=Thu Sep 14 14:32:00 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1573049, encodeId=2f8d15e30490a, content=<a href='/topic/show?id=fef43e52220' target=_blank style='color:#2F92EE;'>#双盲#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37522, encryptionId=fef43e52220, topicName=双盲)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=db3115807173, createdName=xlxchina, createdTime=Thu Sep 14 14:32:00 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1585548, encodeId=0e9915855484b, content=<a href='/topic/show?id=04514581178' target=_blank style='color:#2F92EE;'>#安慰剂对照#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45811, encryptionId=04514581178, topicName=安慰剂对照)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9b4217235139, createdName=guoyibin, createdTime=Thu Sep 14 14:32:00 CST 2017, time=2017-09-14, status=1, ipAttribution=)]
    2017-09-15 游手好闲

    学习了

    0

  6. 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encryptionId=bdc21029931d, topicName=麝香保心丸)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d20233654570, createdName=luwei11, createdTime=Wed Jun 13 13:32:00 CST 2018, time=2018-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=244275, encodeId=59ba2442e57b, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=98dd1959726, createdName=游手好闲, createdTime=Fri Sep 15 11:57:52 CST 2017, time=2017-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243980, encodeId=653724398023, content=谢谢分享了, beContent=null, objectType=article, channel=null, level=null, likeNumber=1, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/07/20/71f2c82f2515186c4d565a27af9ac6f3.jpg, createdBy=84562001987, createdName=午后阳光, createdTime=Thu Sep 14 16:43:57 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1304341, encodeId=fb7a1304341db, content=<a href='/topic/show?id=81724580886' target=_blank style='color:#2F92EE;'>#安慰剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45808, encryptionId=81724580886, topicName=安慰剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4cce318, createdName=wleon8895, createdTime=Thu Sep 14 14:32:00 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1463024, encodeId=0de01463024a2, content=<a href='/topic/show?id=83312253524' target=_blank style='color:#2F92EE;'>#中西医#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22535, encryptionId=83312253524, topicName=中西医)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=693f6527574, createdName=lizhou0206, createdTime=Thu Sep 14 14:32:00 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1573049, encodeId=2f8d15e30490a, content=<a href='/topic/show?id=fef43e52220' target=_blank style='color:#2F92EE;'>#双盲#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37522, encryptionId=fef43e52220, topicName=双盲)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=db3115807173, createdName=xlxchina, createdTime=Thu Sep 14 14:32:00 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1585548, encodeId=0e9915855484b, content=<a href='/topic/show?id=04514581178' target=_blank style='color:#2F92EE;'>#安慰剂对照#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45811, encryptionId=04514581178, topicName=安慰剂对照)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9b4217235139, createdName=guoyibin, createdTime=Thu Sep 14 14:32:00 CST 2017, time=2017-09-14, status=1, ipAttribution=)]
    2017-09-14 午后阳光

    谢谢分享了

    0

  7. 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createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/07/20/71f2c82f2515186c4d565a27af9ac6f3.jpg, createdBy=84562001987, createdName=午后阳光, createdTime=Thu Sep 14 16:43:57 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1304341, encodeId=fb7a1304341db, content=<a href='/topic/show?id=81724580886' target=_blank style='color:#2F92EE;'>#安慰剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45808, encryptionId=81724580886, topicName=安慰剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4cce318, createdName=wleon8895, createdTime=Thu Sep 14 14:32:00 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1463024, encodeId=0de01463024a2, content=<a href='/topic/show?id=83312253524' target=_blank style='color:#2F92EE;'>#中西医#</a>, beContent=null, objectType=article, 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  8. 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    2017-09-14 xlxchina
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