丘脑出血引起Pourfour du Petit综合征一例报道

2019-11-15 剧锦叶 车锋 王荔 齐艳 中华神经医学杂志 神经科病例撷英拾粹

Pourfour du Petit综合征(PdPs)也被称为反Horner综合征。是一种罕见疾病,通常由交感神经通路持续受到刺激所致,其特征为瞳孔散大、睑裂开大、眼球突出和多汗症。PdPs可以由于肿瘤、创伤、出血、畸形等因素所导致。现将山西医科大学第二医院神经内科收治的1例丘脑出血引起PdPs患者的临床资料报道如下。

Pourfour du Petit综合征(PdPs)也被称为反Horner综合征。是一种罕见疾病,通常由交感神经通路持续受到刺激所致,其特征为瞳孔散大、睑裂开大、眼球突出和多汗症。PdPs可以由于肿瘤、创伤、出血、畸形等因素所导致。现将山西医科大学第二医院神经内科收治的1例丘脑出血引起PdPs患者的临床资料报道如下。
 
患者女,63岁,主因记忆力减退1月余,发作性左上肢憋胀麻木感20余天于2017年7月10日入院。患者于1个月前无明显诱因开始出现近期事件记忆力减退,无头晕、头痛,无恶心、呕吐,无肢体行动不便、意识及言语障碍。10d后就诊于当地医院,行头部MRJ诊断为左侧丘脑出血(亚急性期),出血量约3mL,予对症治疗后,症状未见明显缓解。半个月后开始间断出现左手中指憋胀麻木感,后逐渐累及左上肢外侧及左侧面颈部,多于上午休息时加重。7月9日晚上睡前出现左侧面部及左侧上肢外侧出汗及发凉,持续不缓解,为求进一步诊治转入我科。既往史:1年前行右眼白内障手术,目前右眼仍视物模糊。诊断为“白癜风”10年余。无不良嗜好,平素生活较规律。内科系统体检:体温36.05℃,脉搏68次/min,呼吸20次/min,血压131/86mmHg(1mmHg=0.133kPa);心、肺、腹部体检无异常;左侧面部及左侧上肢外侧出汗较右侧增多。神经系统体检:神清语利,近期记忆力下降,计算力、定向力基本正常,对答切题:左侧瞳孔直径3.5mm,右侧瞳孔直径3mm,双侧瞳孔对光反射灵敏。左侧睑裂开大(上下睑缘分别位于角膜上下缘),右侧睑裂正常,左眼轻度前突(经眼球突出计测量,超过右眼1mm),其余颅神经(-);四肢肌力V级,肌张力适中,共济正常,左上肢外侧及左侧面颈部痛觉较右侧过敏,躯干及双下肢感觉正常;双侧腱反射(++),双侧Babinski's征(-)。颈软,Kernig's征,Biudzinski's征(-)。辅助检查:入院后复查头颅MRI示左侧丘脑内片状异常信号影,T1WI呈低信号,T2WI呈混杂信号,双侧半卵圆中心、侧脑室旁、双侧基底节区多发斑点状长T1、长T2异常信号影,T2、FLAIR呈高信号,边缘模糊,弥散加权成像上未见异常信号影,双侧大脑半球对称,脑中线结构居中,脑室系统对称,脑沟、脑裂、脑池增宽,小脑、脑干未见明显异常信号影,双侧颈内动脉颅内段及椎基底动脉显示良好,双侧大脑前中后动脉走行、分布未见明显异常,分支减少,部分分支管壁稍不光整,双侧大脑后动脉管壁纤细。左侧大脑后动脉可见局限性狭窄(图1):颈椎MRI示颈椎退行性变,锥体信号均匀,C3-4、C4-5、C5-6、C6-7椎间盘突出,局部椎管狭窄,脊髓及周围软组织未见明显异常(图2)。叶酸8.64nmol/L,白蛋白36.2g/L,低密度脂蛋白胆固醇3.15mmol/L,同型半胱氨酸20.61μmol/L,钾3.48mmol/L。
 
结合病史、体检及辅助检查,诊断为:脑出血(慢性期早期)、PdPs、脂代谢异常、高同型半胱氨酸血症、白内障(右眼)、白癜风。给予营养神经、脑保护等对症支持治疗后,入院第2天,患者左侧面部及左侧上肢外侧出汗明显减轻,体检:双侧瞳孔等大等圆,直径均为3mm,双眼睑裂正常,自觉左手中指、左上肢外侧及左侧面颈部憋胀麻木感稍有减轻,其余功能基本正常;入院第3天。患者左侧面部及左侧上肢外侧出汗基本消失,体检:仍有左手中指憋胀麻木感、左上肢外侧及左侧面颈部憋胀麻木感,其余功能基本正常。





讨论

PdPs是以法国解剖学家、眼科及外科医生Pourfour du Petit名字命名的颈交感神经综合征。其临床表现恰恰与Horner综合征相反,表现为病变侧瞳孔散大、睑裂开大、眼球突出、头颈上肢或半身皮肤血管收缩以及出汗增多等。自从PdPs被Pourfour du Petit首次提出以来,讨论最多的是其与头痛、颈交感链和臂丛的非穿透性损伤、重型颅脑创伤、胸部肿瘤、甲状腺肿瘤、颈椎间盘突出、主动脉畸形、颅内动脉瘤等的关系。
 
本例患者为老年女性,起病前无劳累、受伤及中毒史,既往有白内障、白癜风,体检有神经功能缺损体征,外院曾行头颅MRI示左侧丘脑出血(接近下丘脑),主要以近期记忆力减退为首要表现,既往无高血压糖尿病病史,无烟、酒、药物嗜好,化验血管炎及类风湿筛查基本正常,入院后检测血压,血压波动在110-140/70-80mmHg,头颅MRI示多发缺血灶,脑动脉硬化伴血管狭窄,考虑此次脑出血原因与动脉硬化有关,丘脑出血半月后逐渐出现左上肢外侧及左侧面颈部出汗,体检双侧瞳孔不等大,左侧睑裂比右侧睑裂稍开大,左眼轻度前突,另外,胸片提示未见异常,临床特点符合PdPs的诊断特点,故诊断PdPs明确。
 
Horner综合征是交感神经路径损伤引起的症状,而反Horner综合征恰好相反,是多种因素刺激交感神经路径,引起瞳孔散大、睑裂开大、眼球突出和多汗症。PdPs的发病机制目前尚不清楚,可能与多种原因有关,每种原因都是以某种方式刺激和兴奋交感神经纤维,而不是抑制交感神经。间脑由丘脑、上丘脑、下丘脑及底丘脑组成。间脑出血部位不同,其临床表现也不尽相同,主要表现为意识障碍、瞳孔异常、眼球运动障碍、偏瘫、偏身感觉障碍、情绪改变及行为异常、植物神经功能紊乱、记忆障碍等症状。下丘脑又称为丘脑下部,位于丘脑下沟的下方,体积很小,但其纤维联系却广泛而复杂,与脑干、基底核、丘脑、边缘系统及大脑皮质之间有密切的联系。下丘脑又被作为交感神经传导径路的高级中枢,从下丘脑发出支配头颈上肢部的中枢神经元,经脑干、C6-T4水平脊髓交感神经(臂丛)神经元换元,最终进入头颈上肢部的靶器官如瞳孔开大肌、提上睑的Muller肌、头颈上肢部汗腺及血管平滑肌等,以上任一部位发生刺激性损伤都可引起同侧的瞳孔散大、眼球突出、睑裂开大、出汗增多。本例患者左上肢外侧及左侧面颈部出汗及瞳孔眼球的转归持续约2d,出现在脑出血后20余天,患者未受外伤,既往无头痛病史,化验甲功正常,胸片正常,颈椎间盘突出未压迫脊髓,可排除头痛、外伤、颈髓压迫、肿瘤导致反Horner综合征的症状,所以笔者认为患者出现PdPs的症状,一方面与血肿吸收,水肿减轻,瘢痕收缩过程出现的刺激反应有关;另一方面,考虑交感神经传导径路中存在一些有抑制交感神经的细胞团,当损伤位于交感神经径路时,表现为Horner综合征,当损伤位于抑制交感神经传导的细胞团时,表现出交感神经刺激症状,从既往的报道可以分析出,这种抑制细胞团是多发或者说广泛存在的:而从其夜间发病可以推测,这些细胞团的功能不光是抑制交感神经传导,还参与到睡眠周期中。
 
由于PdPs持续时间可从短暂的几小时到几个月,或者一旦潜在的刺激停止,症状可能很快消退,表现为神经功能缺损症状,而且一般情况下会伴随其他症状同时出现,所以容易被眼科医生和神经科医生忽视。总之,PdPs临床少见,临床医生应加强对该疾病症状及发病机制的了解,减少误诊,并及时给予对症治疗,特别是在患者的临床症状没有缓解的情况下,以避免错过最佳治疗时间。

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time=2019-11-15, status=1, ipAttribution=)]
  3. 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time=2019-11-15, status=1, ipAttribution=)]
    2020-08-24 feather89
  4. 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  6. 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encryptionId=15e2140e438, topicName=PET)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTI5PdY90y5Jib8FnPhCXTR2d9v3K17epNSwB2eb0vmXUldNJl2e72S4unZTAHLAojicdVSialTDFHAxA/132, createdBy=78d82500042, createdName=ms7514935887898259, createdTime=Sun Nov 17 05:08:00 CST 2019, time=2019-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1431683, encodeId=692d143168308, content=<a href='/topic/show?id=f9b9e9124a8' target=_blank style='color:#2F92EE;'>#综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79124, encryptionId=f9b9e9124a8, topicName=综合征)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Sun Nov 17 05:08:00 CST 2019, time=2019-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1558313, encodeId=701e15583131b, content=<a href='/topic/show?id=c8a7208e8a8' target=_blank style='color:#2F92EE;'>#丘脑#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20878, encryptionId=c8a7208e8a8, topicName=丘脑)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fb8814960000, createdName=xlwang2696, createdTime=Sun Nov 17 05:08:00 CST 2019, time=2019-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1564322, encodeId=441e156432257, content=<a href='/topic/show?id=c8a7208e8a8' target=_blank style='color:#2F92EE;'>#丘脑#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20878, encryptionId=c8a7208e8a8, topicName=丘脑)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fb8814960000, createdName=xlwang2696, createdTime=Sun Nov 17 05:08:00 CST 2019, time=2019-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=375210, encodeId=4b093e521015, content=非常精彩,受益非浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7b005228115, createdName=14794e5bm67(暂无昵称), createdTime=Fri Nov 15 17:49:26 CST 2019, time=2019-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=375209, encodeId=d70c3e520906, content=非常精彩,受益非浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7b005228115, createdName=14794e5bm67(暂无昵称), createdTime=Fri Nov 15 17:49:18 CST 2019, time=2019-11-15, status=1, ipAttribution=)]
    2019-11-17 xlwang2696
  7. [GetPortalCommentsPageByObjectIdResponse(id=2033651, encodeId=e05620336516a, content=<a href='/topic/show?id=87ec2088178' target=_blank style='color:#2F92EE;'>#丘脑出血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20881, encryptionId=87ec2088178, topicName=丘脑出血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=40be178, createdName=zhyy88, createdTime=Mon Mar 09 13:08:00 CST 2020, time=2020-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1787094, encodeId=1be41e8709406, content=<a href='/topic/show?id=0ebc1408ee2' target=_blank style='color:#2F92EE;'>#Petit综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14087, encryptionId=0ebc1408ee2, topicName=Petit综合征)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=db5b227, createdName=gostraight, createdTime=Wed Feb 19 05:08:00 CST 2020, time=2020-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1728196, encodeId=890b1e281962f, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Mon Aug 24 15:08:00 CST 2020, time=2020-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1331144, encodeId=99dc13311443a, content=<a href='/topic/show?id=15e2140e438' target=_blank style='color:#2F92EE;'>#PET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=17, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14074, encryptionId=15e2140e438, topicName=PET)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTI5PdY90y5Jib8FnPhCXTR2d9v3K17epNSwB2eb0vmXUldNJl2e72S4unZTAHLAojicdVSialTDFHAxA/132, createdBy=78d82500042, createdName=ms7514935887898259, createdTime=Sun Nov 17 05:08:00 CST 2019, time=2019-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1431683, encodeId=692d143168308, content=<a href='/topic/show?id=f9b9e9124a8' target=_blank style='color:#2F92EE;'>#综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79124, encryptionId=f9b9e9124a8, topicName=综合征)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Sun Nov 17 05:08:00 CST 2019, time=2019-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1558313, encodeId=701e15583131b, content=<a href='/topic/show?id=c8a7208e8a8' target=_blank style='color:#2F92EE;'>#丘脑#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20878, encryptionId=c8a7208e8a8, topicName=丘脑)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fb8814960000, createdName=xlwang2696, createdTime=Sun Nov 17 05:08:00 CST 2019, time=2019-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1564322, encodeId=441e156432257, content=<a href='/topic/show?id=c8a7208e8a8' target=_blank style='color:#2F92EE;'>#丘脑#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20878, encryptionId=c8a7208e8a8, topicName=丘脑)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fb8814960000, createdName=xlwang2696, createdTime=Sun Nov 17 05:08:00 CST 2019, time=2019-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=375210, encodeId=4b093e521015, content=非常精彩,受益非浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7b005228115, createdName=14794e5bm67(暂无昵称), createdTime=Fri Nov 15 17:49:26 CST 2019, time=2019-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=375209, encodeId=d70c3e520906, content=非常精彩,受益非浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7b005228115, createdName=14794e5bm67(暂无昵称), createdTime=Fri Nov 15 17:49:18 CST 2019, time=2019-11-15, status=1, ipAttribution=)]
    2019-11-17 xlwang2696
  8. [GetPortalCommentsPageByObjectIdResponse(id=2033651, encodeId=e05620336516a, content=<a href='/topic/show?id=87ec2088178' target=_blank style='color:#2F92EE;'>#丘脑出血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20881, encryptionId=87ec2088178, topicName=丘脑出血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=40be178, createdName=zhyy88, createdTime=Mon Mar 09 13:08:00 CST 2020, time=2020-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1787094, encodeId=1be41e8709406, content=<a href='/topic/show?id=0ebc1408ee2' target=_blank style='color:#2F92EE;'>#Petit综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14087, encryptionId=0ebc1408ee2, topicName=Petit综合征)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=db5b227, 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2019, time=2019-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1558313, encodeId=701e15583131b, content=<a href='/topic/show?id=c8a7208e8a8' target=_blank style='color:#2F92EE;'>#丘脑#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20878, encryptionId=c8a7208e8a8, topicName=丘脑)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fb8814960000, createdName=xlwang2696, createdTime=Sun Nov 17 05:08:00 CST 2019, time=2019-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1564322, encodeId=441e156432257, content=<a href='/topic/show?id=c8a7208e8a8' target=_blank style='color:#2F92EE;'>#丘脑#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20878, encryptionId=c8a7208e8a8, topicName=丘脑)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fb8814960000, createdName=xlwang2696, createdTime=Sun Nov 17 05:08:00 CST 2019, time=2019-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=375210, encodeId=4b093e521015, content=非常精彩,受益非浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7b005228115, createdName=14794e5bm67(暂无昵称), createdTime=Fri Nov 15 17:49:26 CST 2019, time=2019-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=375209, encodeId=d70c3e520906, content=非常精彩,受益非浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7b005228115, createdName=14794e5bm67(暂无昵称), createdTime=Fri Nov 15 17:49:18 CST 2019, time=2019-11-15, status=1, ipAttribution=)]
    2019-11-15 14794e5bm67(暂无昵称)

    非常精彩,受益非浅

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=2033651, encodeId=e05620336516a, content=<a href='/topic/show?id=87ec2088178' target=_blank style='color:#2F92EE;'>#丘脑出血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20881, encryptionId=87ec2088178, topicName=丘脑出血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=40be178, createdName=zhyy88, createdTime=Mon Mar 09 13:08:00 CST 2020, time=2020-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1787094, encodeId=1be41e8709406, content=<a href='/topic/show?id=0ebc1408ee2' target=_blank style='color:#2F92EE;'>#Petit综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14087, encryptionId=0ebc1408ee2, topicName=Petit综合征)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=db5b227, 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2019, time=2019-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1558313, encodeId=701e15583131b, content=<a href='/topic/show?id=c8a7208e8a8' target=_blank style='color:#2F92EE;'>#丘脑#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20878, encryptionId=c8a7208e8a8, topicName=丘脑)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fb8814960000, createdName=xlwang2696, createdTime=Sun Nov 17 05:08:00 CST 2019, time=2019-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1564322, encodeId=441e156432257, content=<a href='/topic/show?id=c8a7208e8a8' target=_blank style='color:#2F92EE;'>#丘脑#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20878, encryptionId=c8a7208e8a8, topicName=丘脑)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fb8814960000, createdName=xlwang2696, createdTime=Sun Nov 17 05:08:00 CST 2019, time=2019-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=375210, encodeId=4b093e521015, content=非常精彩,受益非浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7b005228115, createdName=14794e5bm67(暂无昵称), createdTime=Fri Nov 15 17:49:26 CST 2019, time=2019-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=375209, encodeId=d70c3e520906, content=非常精彩,受益非浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7b005228115, createdName=14794e5bm67(暂无昵称), createdTime=Fri Nov 15 17:49:18 CST 2019, time=2019-11-15, status=1, ipAttribution=)]
    2019-11-15 14794e5bm67(暂无昵称)

    非常精彩,受益非浅

    0