盘点:心梗近期重要研究进展汇总

2018-04-25 MedSci MedSci原创

心肌梗死又叫心肌梗塞,心肌梗塞是冠状动脉闭塞,血流中断,使部分心肌因严重的持久性缺血而发生局部坏死。临床上有剧烈而较持久的胸骨后疼痛,发热、白细胞增多、红细胞沉降率加快,血清心肌酶活力增高及进行性心电图变化,可发生心律失常、休克或心力衰竭。这里梅斯小编整理了近期关于心梗的重要研究进展与大家一同分享。【1】无症状的心梗心衰的发生风险未必低http://www.medsci.cn/articl

心肌梗死又叫心肌梗塞,心肌梗塞是冠状动脉闭塞,血流中断,使部分心肌因严重的持久性缺血而发生局部坏死。临床上有剧烈而较持久的胸骨后疼痛,发热、白细胞增多、红细胞沉降率加快,血清心肌酶活力增高及进行性心电图变化,可发生心律失常、休克或心力衰竭。这里梅斯小编整理了近期关于心梗的重要研究进展与大家一同分享。

【1】无症状的心梗心衰的发生风险未必低

尽管寂静型心肌梗死(SMI)占了心梗患者的近一半,但是目前对于SMI患者发生心衰的风险如何尚属未知。近期,一项研究纳入了ARIC临床研究中的9243名无基础心血管疾病的研究对象,旨在比较评估SMI患者与有临床症状的心梗(CMI)患者发生心衰的相关性。在ARIC随访1期和4期期间,共有305名SMI患者和331CMI患者,ARIC4期临床研究之后的13年随访期间,共有976个心衰事件发生,与无心梗的参与对象相比,SMI和CMI患者发生心衰的风险均更高,经多变量分析调整后,这种增高同样明显。此外,在寂静型心梗患者中,心衰发生风险高的群体更年轻。表明无症状的寂静型心梗患者发生心衰的风险同样更高,且年龄更小。

【2】大部分年轻心梗患者没有达到接受他汀类药物治疗的标准

尽管重视对心梗的预防,然而心梗在年轻的成年人中的发病率仍较高。研究人员收集来自YOUNG-MI注册数据库的数据,纳入了年龄≤50岁的心梗患者,并有对应的内科专家对心梗进行诊断和分型,通过混合队列风险方程评估心梗前和心梗发生中动脉粥样硬化性心血管疾病的风险。最终分析了1475名患者,平均年龄为45岁,294名为女性,846名患者有ST段抬高型心梗。在1225名患者中至少有一个心血管疾病危险因素,所有患者的10年平均动脉粥样硬化性心血管疾病风险为4.8%(2.8%-8.0%)。根据2013年美国心脏病协会指南和2016年美国预防服务工作建议,仅有分别724 (49%) 和430 (29%)名患者符合他汀类药物治疗标准。在女性患者中更显着,有184名(63%)女性患者没有达到他汀类药物治疗标准,而男性为549 (46%) 名(p < 0.001)。表明目前大部分年轻心梗患者并没有达到接受他汀类药物治疗的标准。

【3】脂质、脂蛋白与代谢标志物水平对心梗和卒中的影响

血脂水平是心肌梗死(MI)的危险因素,但是脂质颗粒、脂蛋白颗粒和循环血液中代谢产物与MI和卒中亚型的关系尚未确定。一项巢氏病例对照研究评估了血浆代谢标志物水平与MI、缺血性卒中(IS)和颅内出血(ICH)之间的相关性。共纳入912例MI患者、1146例IS患者、1138例ICH患者和1466例正常对照,年龄在30-79岁之间,并对所有患者的225个代谢标志物基线水平进行检测。结果分析发现,极低、中密度和低密度脂蛋白颗粒水平与MI和IS的发生呈正相关,高密度脂蛋白水平与MI的发生呈负相关,而脂蛋白颗粒水平与ICH不呈相关性。大的高密度脂蛋白胆固醇与MI和IS的发生呈负相关。所有脂蛋白的甘油三酯均与MI的发生呈正相关,IS也有相似的结果,乙酰糖蛋白、酮体、葡萄糖和二十二碳六烯酸与三种疾病的发生均呈相关性。此外,这225个代谢标志物水平与MI和IS的相关性一致,与ICH不一致。表明脂蛋白和脂质水平与心梗和缺血性卒中的相关性一致,与颅内出血不一致。

【4】心梗伴心衰患者如何评估卒中发生风险

不伴有房颤的心梗患者也会有发生卒中的风险。新的研究旨在探索出一套评估心梗伴心衰和/或收缩功能不全患者卒中发生风险的评分体系。研究纳入了来自4个临床试验的22904名无房颤的心梗患者,平均随访1.9年。结果660名(2.9%)患者出现了卒中,这些患者的年龄更大,女性更常见,并且更容易抽烟和高血压,另外,这些患者的肾小球滤过率更低,有心梗、心衰、糖尿病和卒中疾病史的比例更高。最终,评分系统里保留了以下危险因素:高龄,Killip分级3或4级,肾小球滤过率≤45 ml/min/1.73 m2,高血压和卒中疾病史。该模型已经校准,并且具备较好的辨识度(C-index = 0.67)。总之,本研究探索出了一套能较准确评估心梗伴心衰患者发生卒中发生风险的评分体系,包括高龄,Killip分级3或4级,肾小球滤过率≤45 ml/min/1.73 m2,高血压和卒中疾病史。


【5】BNP 5-32可作为急性心梗危险分层的二级标志物

B型钠尿肽(BNP)是急性心梗危险分层的一个标志物,近期,BNP的截断蛋白分子被发现,但其作为心梗危险分层的功能尚未阐明。本研究的目的旨在评估BNP的截断蛋白分子在心梗危险分层中的作用。纳入了1078名急性心梗患者,对其血浆的BNP 5-32, BNP 4-32和BNP 3-32水平进行检测,并且随访观察患者的短期和长期预后。结果分析发现,BNP的截断蛋白分子水平是患者6个月、1年和2年发生死亡/心肌梗死、心衰源性死亡/再住院和复合心血管不良事件的独立预测因子,并且与传统的BNP预测效果相当。重新分类分析后发现,BNP的截断蛋白分子联合GRACE临床危险评分可以成功对心梗患者的危险重新分层。表明BNP的截断蛋白分子水平与急性心梗患者的不良预后相关,BNP 5-32可联合NT-proBNP作为危险分层的二级标志物。

【6】学术会议期间急性心梗患者的死亡率更低

既往有研究报道在国际心血管学术会议期间,教学医院的急性心血管事件的30天死亡率更低。研究纳入分析了2007年至2013年有国际心血管学术会议期间的主要教学医院的急性心梗住院患者的30天死亡率,并对比分析了非会议期间的死亡率。分析结果发现,校正前后患者30天死亡率在国际心血管学术会议期间住院的患者中更低。心脏介入的干预率在两组患者之前是相似的,经皮冠脉介入比率也相似。死亡率降低最多的患者是未接受经皮冠脉介入治疗的非ST段抬高型梗死患者。表明急性心梗患者的30天死亡率在国际心血管学术会议期间要更低,尤其是非ST段抬高型梗死患者。

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    2018-05-01 guicaiwei

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content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Wed Apr 25 09:08:24 CST 2018, time=2018-04-25, status=1, ipAttribution=)]
  3. 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createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Thu Apr 26 12:05:55 CST 2018, time=2018-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309464, encodeId=de043094648e, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Thu Apr 26 12:05:52 CST 2018, time=2018-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309463, encodeId=9cc330946303, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Thu Apr 26 12:05:50 CST 2018, time=2018-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309462, encodeId=d5a53094626f, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Thu Apr 26 12:05:47 CST 2018, time=2018-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309205, encodeId=ebb03092056c, content=已学习.感谢你的关心., beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20231215/ac08b4d4cecf4bd3b9af86e00dcbca38/f6b6a60efd854ff191eb5c611ec7dd12.jpg, createdBy=8afb2071832, createdName=15938038573红旗飘飘, createdTime=Wed Apr 25 18:46:00 CST 2018, time=2018-04-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309119, encodeId=a45930911985, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Wed Apr 25 09:08:26 CST 2018, time=2018-04-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309118, encodeId=6e6e3091188b, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Wed Apr 25 09:08:24 CST 2018, time=2018-04-25, status=1, ipAttribution=)]
    2018-04-26 哈哈869

    学了

    0

  4. 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topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Thu Apr 26 12:05:50 CST 2018, time=2018-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309462, encodeId=d5a53094626f, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Thu Apr 26 12:05:47 CST 2018, time=2018-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309205, encodeId=ebb03092056c, content=已学习.感谢你的关心., beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20231215/ac08b4d4cecf4bd3b9af86e00dcbca38/f6b6a60efd854ff191eb5c611ec7dd12.jpg, createdBy=8afb2071832, createdName=15938038573红旗飘飘, createdTime=Wed Apr 25 18:46:00 CST 2018, time=2018-04-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309119, encodeId=a45930911985, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Wed Apr 25 09:08:26 CST 2018, time=2018-04-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309118, encodeId=6e6e3091188b, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Wed Apr 25 09:08:24 CST 2018, time=2018-04-25, status=1, ipAttribution=)]
    2018-04-26 哈哈869

    学了

    0

  5. 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topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Thu Apr 26 12:05:50 CST 2018, time=2018-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309462, encodeId=d5a53094626f, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Thu Apr 26 12:05:47 CST 2018, time=2018-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309205, encodeId=ebb03092056c, content=已学习.感谢你的关心., beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20231215/ac08b4d4cecf4bd3b9af86e00dcbca38/f6b6a60efd854ff191eb5c611ec7dd12.jpg, createdBy=8afb2071832, createdName=15938038573红旗飘飘, createdTime=Wed Apr 25 18:46:00 CST 2018, time=2018-04-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309119, encodeId=a45930911985, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Wed Apr 25 09:08:26 CST 2018, time=2018-04-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309118, encodeId=6e6e3091188b, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Wed Apr 25 09:08:24 CST 2018, time=2018-04-25, status=1, ipAttribution=)]
    2018-04-26 哈哈869

    学了

    0

  6. 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createdName=mashirong, createdTime=Thu Apr 26 23:05:00 CST 2018, time=2018-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309466, encodeId=fdcd30946671, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Thu Apr 26 12:05:58 CST 2018, time=2018-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309465, encodeId=55c8309465f0, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Thu Apr 26 12:05:55 CST 2018, time=2018-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309464, encodeId=de043094648e, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Thu Apr 26 12:05:52 CST 2018, time=2018-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309463, encodeId=9cc330946303, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Thu Apr 26 12:05:50 CST 2018, time=2018-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309462, encodeId=d5a53094626f, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Thu Apr 26 12:05:47 CST 2018, time=2018-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309205, encodeId=ebb03092056c, content=已学习.感谢你的关心., beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20231215/ac08b4d4cecf4bd3b9af86e00dcbca38/f6b6a60efd854ff191eb5c611ec7dd12.jpg, createdBy=8afb2071832, createdName=15938038573红旗飘飘, createdTime=Wed Apr 25 18:46:00 CST 2018, time=2018-04-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309119, encodeId=a45930911985, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Wed Apr 25 09:08:26 CST 2018, time=2018-04-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309118, encodeId=6e6e3091188b, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Wed Apr 25 09:08:24 CST 2018, time=2018-04-25, status=1, ipAttribution=)]
    2018-04-26 哈哈869

    学了

    0

  7. 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channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20231215/ac08b4d4cecf4bd3b9af86e00dcbca38/f6b6a60efd854ff191eb5c611ec7dd12.jpg, createdBy=8afb2071832, createdName=15938038573红旗飘飘, createdTime=Wed Apr 25 18:46:00 CST 2018, time=2018-04-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309119, encodeId=a45930911985, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Wed Apr 25 09:08:26 CST 2018, time=2018-04-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309118, encodeId=6e6e3091188b, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Wed Apr 25 09:08:24 CST 2018, time=2018-04-25, status=1, ipAttribution=)]
    2018-04-26 哈哈869

    学了

    0

  8. 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channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20231215/ac08b4d4cecf4bd3b9af86e00dcbca38/f6b6a60efd854ff191eb5c611ec7dd12.jpg, createdBy=8afb2071832, createdName=15938038573红旗飘飘, createdTime=Wed Apr 25 18:46:00 CST 2018, time=2018-04-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309119, encodeId=a45930911985, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Wed Apr 25 09:08:26 CST 2018, time=2018-04-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309118, encodeId=6e6e3091188b, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Wed Apr 25 09:08:24 CST 2018, time=2018-04-25, status=1, ipAttribution=)]
    2018-04-25 15938038573红旗飘飘

    已学习.感谢你的关心.

    0

  9. 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    2018-04-25 哈哈869

    学了

    0

  10. 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    2018-04-25 哈哈869

    学了

    0

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