必看:近期冠心病重磅研究汇总

2017-02-18 MedSci MedSci原创

冠心病是全球常见病、多发病,严重危害人类健康和生存质量。尽管近年来心血管疾病的诊疗方法已取得突飞猛进的发展,但其死亡率仍占全世界总疾病死亡率的30%,远远超过癌症等其他疾病。转眼间,2017年即已悄然过去一个多月,本文小编就为大家汇总了1月以来冠心病重磅研究,与大家分享。【1】Diabetes Care:甘油三酯和HDL-C血脂异常与冠心病和缺血性脑卒中风险分析!高水平甘油三酯(TG)和低水平

冠心病是全球常见病、多发病,严重危害人类健康和生存质量。尽管近年来心血管疾病的诊疗方法已取得突飞猛进的发展,但其死亡率仍占全世界总疾病死亡率的30%,远远超过癌症等其他疾病。

转眼间,2017年即已悄然过去一个多月,本文小编就为大家汇总了1月以来冠心病重磅研究,与大家分享。


高水平甘油三酯(TG)和低水平高密度脂蛋白胆固醇(HDL-C)是心血管疾病的危险因素。目前尚不清楚这种关系是否取决于血糖失调、性别或LDL-C水平。近日,糖尿病领域权威杂志Diabetes Care针对这一临床问题发表了一篇研究文章。

研究人员分析了3216名参与者(40%为男性,41%为糖尿病患者),这些参与者来自于美国印第安人以社区为基础的前瞻性队列(中位随访17.7年),并且在研究之初无心血管疾病。研究人员通过Cox比例风险模型估计了与TG和HDL-C水平相关的发生缺血性脑卒中与冠心病(CHD)的风险险比和95%可信区间,其中空腹TG水平≥150mg/dL被认为是“高”水平,而空腹HDL-C水平男性<40mg/dL(女性<50 mg/dL)被认为是“低”水平。这一模型包括了年龄、性别、BMI、吸烟、糖尿病、空腹LDL-C水平、抗高血压药物、体力活动、估计的肾小球滤过率和尿白蛋白/肌酐比值。

研究人员发现高TG水平和低HDL-C水平的参与者发生CHD的风险比是正常TG和HDL水平参与者的1.32倍(95%可信区间为1.06-1.64)。在糖尿病患者中也可以观察到该现象,但在那些没有糖尿病的患者中没有观察到该现象。高TG水平加上低HDL-C水平可导致CHD风险比增加1.54倍(95%可信区间为1.15-2.06)(P相互作用=0.003)而发生脑卒中的风险比增加2.13倍(95%可信区间为1.06-4.29)(P相互作用=0.060)。高TG水平和低HDL水平与LDL-C水平≥130mg/dL参与者的CHD风险相关,但这种相关在那些低LDL-C水平参与者中没有观察到。性别似乎没有改变这些相关性。

由此可见,高TG水平和低HDL水平成人,尤其是那些有糖尿病患者,其发生CHD和脑卒中风险增加。特别是,那些LDL-C水平≥130mg/dL的参与者可能发生脑卒中的风险增加。


最近发现血清氯化物水平与心力衰竭患者死亡率独立相关。近日,心血管领域权威杂志Circ-Heart Fail上针对这一问题发表了一篇研究文章。

研究人员分析了7195例急性心肌梗死合并左心室功能降低和心力衰竭患者,用于调查患者血清中氯含量与临床结局之间的关系。该研究的结局是全因死亡率、心血管死亡率和因心衰住院情况。

研究人员发现血清中氯和钠水平与研究结局呈非线性相关(线性P<0.05)。血氯含量位于最低三分位数范围(氯化物含量≤100mmol/L)的患者年龄较大,有更多的合并症,并有较低的血钠含量(所有P<0.05)。对于所有研究结局,血清氯含量显示出与血清钾有着显著的相互作用(所有相互作用P<0.05)。血氯含量位于最低三分位数范围(氯化物含量≤100mmol/L)在较低钠含量(≤138mmol/L)的情况下与患者死亡率的增加相关(全因死亡率调整后的风险比[95%可信区间]为1.42(1.14-1.77);P=0.002),然而,在较高钠含量的情况下(>141mmol/L),这种与死亡率之间的相关性则消失了。样条转化的氯含量及其与钠含量的相互作用并没有显著将预后信息添加到其他既定的预后变量之上(所有结局的P>0.05)。

由此可见,在伴有收缩功能不全和心力衰竭的心肌梗死后患者中,在低血钠的情况下,低血氯含量与死亡率(但与因心衰住院无关)相关。总体而言,血氯含量及其与血钠含量的相互作用并没有显著将预后信息添加到其他既定的预后变量之上。总之,这些数据支持综合和重点考虑血氯和血钠之间的相互作用。


缺血性心脏病引起的射血分数减少的心力衰竭与患者发病率和死亡率增加有关。相比于药物治疗的射血分数减少的心力衰竭患者,对这些患者进行冠状动脉旁路移植术(CABG)或经皮冠状动脉介入治疗(PCI)的血管重建术是否能给患者带来获益还是风险,目前尚不清楚。近日,心血管领域权威杂志Circ-Heart Fail上针对这一问题发表了一篇荟萃分析文章。

研究人员对可用的研究进行了Meta分析比较了对左心室射血分数≤40%的冠状动脉疾病患者进行不同的血运重建方法(PCI或CABG)或与药物治疗的疗效。该研究的主要终点为全因死亡率;研究人员同时也分析了患者心肌梗死、脑卒中和血运重建的情况。研究者共纳入了21项临床研究共涉及16191例患者。

与接受药物治疗的患者相比,接受CABG(风险比为0.66;95%可信区间为0.61–0.72;P<0.001)和PCI(风险比为0.73;95%可信区间为0.62–0.85;P<0.001)可以显著降低患者的死亡率。与接受PCI的患者相比,接受CABG仍然显示具有生存获益(风险比为0.82;95%可信区间为0.75–0.90;P<0.001)。

该项荟萃分析结果表明,血运重建策略对改善缺血性心脏病和降低左室射血分数的患者的生存率都优于药物治疗。对于这个特定的临床疾病,在2种血运重建策略之间比较,CABG似乎比PCI更有利。


最近,顶级杂志BMJ上发表了一篇荟萃分析文章,研究者旨在对没有心脏衰竭的冠状动脉疾病的患者用肾素-血管紧张素系统抑制剂治疗相比于阳性对照和安慰剂的疗效评估。 

在这项对随机试验的Meta分析中,研究人员检索了PubMed、EMBASE和CENTRAL 等数据库,时间直到2016年5月1日。在没有心脏衰竭(定义为左室射血分数≥40%或无临床心衰)的冠状动脉疾病的患者中比较肾素-血管紧张素系统抑制剂治疗与阳性对照和安慰剂疗效的临床全部被纳入。每一个试验至少要招募100名无心脏衰竭的冠心病患者,至少随访一年。如果使用血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂进行疗效比较的研究予以排除。结果指标包括死亡、心血管死亡、心肌梗死、心绞痛、卒中、心脏衰竭、血运重建、糖尿病和由于不良反应的停药物。
 
分析共纳入了24个研究包括198275人年的随访。相比于安慰剂组,肾素-血管紧张素系统抑制剂可以降低全因死亡率(比值比为0.84,95%可信区间为0.72-0.98)、心血管死亡率(0.74,0.59-0.94)、心肌梗死(0.82,0.76-0.88)、卒中(0.79,0.70-0.89)、心绞痛、心力衰竭、血管重建的风险;但与阳性对照组比不存在风险降低(全因死亡率比值比为1.05、0.94-1.17;P相互作用为0.006;心血管疾病死亡率比值比为1.08、0.93-1.25 P相互作用<0.001;心肌梗死比值比为0.99,0.87-1.12,P相互作用为0.01;卒中比值比为1.10,0.93-1.31;P相互作用为0.002)。贝叶斯Meta回归分析表明,在全因死亡率和心血管疾病死亡率方面,相比于安慰剂,肾素-血管紧张素系统抑制剂的疗效依赖于对照组事件发生率,如肾素-血管紧张素系统抑制剂在高对照事件发生率的试验中是唯一有益的治疗(每1000病人年>14.10例死亡和>7.65例心血管死亡),而在那些低对照事件发生率的试验中不存在这一效应。 


近日,心血管疾病领域权威杂志JAHA上发表了一篇研究文章,研究人员旨在评估动脉粥样硬化的多民族研究(MESA研究)(一个由白人、中国人、黑人和西班牙裔人组成的多民族队列)。

研究人员获取了年龄在45-84岁参与者的IMT数据。研究人员计算了MESA研究每一名参与者颈总动脉和颈内动脉IMT、性别和人种/民族特定的规范值以及组合成IMT评分。研究人员采用多变量Cox‐比例风险模型和Logistic回归模型来评估冠心病的预后,并将IMT评分加入到(1)性别、人种/民族和弗雷明汉危险因素的基础模型,(2)冠状动脉钙化的基础模型。研究人员估计了Harrell’s C统计量和曲线下面积。

研究人员对429例首次发生冠心病的患者进行了中位随访时间为10.2年(四分位距为9.7-10.7年)的随访。这些患者的平均年龄为62.1岁,参与者52.6%为女性。IMT评分使基础的曲线下面积从0.7210增加到了0.7396(P=0.0008),并且将阳性冠状动脉钙化积分加入到该模型中,则从0.7627增加到0.7714(P=0.02)。

由此可见,颈动脉IMT评分是基于规范的数据,逐步加入到弗雷明汉危险因素和冠状动脉钙化评分来预测不同种族的人群首次发生的冠心病。


近日发表于《BMJ》的一项meta分析显示,并无充分证据支持肾素血管紧张素系统抑制剂作为无心衰冠心病患者的优选治疗药物。

来自纽约大学Langone医学中心的Sripal Bangalore等人表示,在无心衰的稳定性冠心病患者中,肾素血管紧张素系统抑制剂仅在与安慰剂对比时可减少心血管事件和死亡率,但与其他药物相比时并无明显的优势。即使是在本研究的安慰剂对照试验中,肾素血管紧张素系统抑制剂的获益也只能见于对照组事件率较高的试验,而对照组事件率较低的试验也未见明显获益。

Bangalore等人对24项随机试验进行了meta分析,所有试验都是评估肾素血管紧张素系统(RAS)抑制剂 vs 安慰剂或阳性对照的随机研究。各试验至少入选100例受试者,至少随访1年。所有受试者都是无心衰(左室射血分数达40%或不存在心衰临床表现)的稳定性冠心病患者。研究者并未入选对比ACEI和血管紧张素受体阻滞剂的研究。

最后研究者表示,即使是在安慰剂对照试验中,RAS抑制剂的疗效也仅见于受试者基线风险较高的试验,在基线低危受试者中没有获益。因此,该证据并不支持指南全权推荐所有冠心病患者优选RAS抑制剂。


全基因组关联研究已经确定了影响人类循环脂质浓度的位点;通过对表观遗传修饰的研究可以获得新的与疾病相关的基因、通路和生物学的进一步信息。最近,心血管领域权威杂志Circulation-cardiovascular genetics上发表了一项表观遗传修饰研究成果。

为了确定与血脂水平相关的表观遗传学改变,研究人员检测了来自于2个人群为基础的队列中的2306人全血中全基因组胞嘧啶鸟嘌呤二核苷酸(CpGs)DNA甲基化情况,并在另外2025人中对这一发现进行重复。

研究人员在发现阶段确定了193个与血脂水平相关的CpGs(P<1.08E-07)并在重复阶段有33个(经Bonferroni校正P<0.05),其中包括25个以前没有报道的与血脂相关的新CpGs。脂质相关CpGs基因富集在脂肪和氨基酸代谢过程。一个与甘油三酯和高密度脂蛋白胆固醇(HDL-C;cg27243685;P=8.1E-26和9.3E-19)相关的差异甲基化位点与胆固醇逆向转运体(ABCG1;P=7.2E-28)的顺式表达与心血管疾病事件(每一SD增量的风险比为1.38;95%可信区间为1.15-1.66;P=0.0007)相关。研究人员发现193个CpGs其中的64%的显著顺式甲基化的数量性状位点富集了血脂水平(PTC=0.004,PHDL-C=0.008和P甘油三酯=0.00003)和冠心病(P=0.0007)相关信号,从全基因组关联研究中分析得出。例如,与低密度脂蛋白胆固醇和冠心病相关的基因组显著变异位于APOB,其是低密度脂蛋白胆固醇相关差异甲基化位点的顺式甲基化数量性状位点。

研究人员报道了与血脂水平相关的新DNA甲基化,描述与以前的全基因组关联研究发现相关的表观遗传机制,并提供证据表明血液中胆固醇逆向转运体的表观遗传调控与心血管疾病事件的发生相关。


近日,心血管领域权威杂志Circulation: Cardiovascular Interventions上发表了一篇研究文章,研究人员旨在评估对阿司匹林敏感的接受冠状动脉造影患者进行标准快速的脱敏疗法的安全性和有效性。

这是一项前瞻性、多中心观察性研究,包括7个意大利中心,纳入了对阿司匹林敏感接受了冠状动脉造影的患者,并且这些患者有意图进行经皮冠状动脉介入治疗。总共有330例对阿司匹林敏感并且已知/怀疑患有稳定的冠状动脉疾病或发生急性冠脉综合征包括ST段抬高心肌梗死的患者被招募入研究。

阿司匹林的不良反应包括荨麻疹(n=177,53.6%)、血管性水肿(n=69,20.9%)、哮喘(n=65,19.7%)和过敏性反应(n=19,5.8%)。在荨麻疹/血管性水肿的患者中,13例(3.9%)患者有慢性特发性荨麻疹史。所有患者均接受快速阿司匹林(5.5小时)脱敏治疗。所有患者在接受心脏导管插入术之前进行脱敏治疗,除了那些(n=78,23.6%)ST段抬高的心肌梗死患者,其脱敏治疗进行在经皮冠状动脉介入治疗之后。在整个研究人群中接受经皮冠状动脉介入治疗的患者有235例(71%)。脱敏治疗成功的有315例(95.4%)患者,所有患者都有过敏性反应史。在对脱敏治疗失败的15例患者(4.6%)中,不良反应较为轻微,糖皮质激素和抗组胺药治疗有效。在住院阿司匹林脱敏成功的患者中,253例(80.3%)患者继续服用阿司匹林治疗至少12个月。对脱敏治疗有反应的62例(19.7%)患者因为医疗决定而不是由于过敏反应而停用阿司匹林治疗。

由此可见,不论阿司匹林过敏的表现类型,标准快速脱敏疗法在有迹象表明需要接受冠状动脉造影和有意向进行经皮冠状动脉介入治疗的患者中运用是安全有效的。

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1549039, encodeId=ec0a154903953, content=<a href='/topic/show?id=f7879600061' target=_blank style='color:#2F92EE;'>#重磅#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96000, encryptionId=f7879600061, topicName=重磅)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3acc14121561, createdName=xxxx1054, createdTime=Mon Feb 20 12:06:00 CST 2017, time=2017-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=177098, encodeId=47221e709881, content=小编辛苦了,感谢为我们准备了绝佳的精神晚餐,给点赞了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Mon Feb 20 08:34:47 CST 2017, time=2017-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176984, encodeId=81a51e698438, content=好好努力, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Feb 19 15:03:30 CST 2017, time=2017-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176971, encodeId=8bc01e6971e3, content=文章真心不错耶, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sun Feb 19 14:00:01 CST 2017, time=2017-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176955, encodeId=ab291e69556b, content=学习了,有待临床进一步研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=387d1660055, createdName=dhzzm, createdTime=Sun Feb 19 12:02:17 CST 2017, time=2017-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176875, encodeId=175c1e6875aa, content=学习了,很前沿的知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Sat Feb 18 21:54:13 CST 2017, time=2017-02-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176874, encodeId=2b8e1e68745d, content=这个软件超好, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=53111694095, createdName=1de65cf8m77(暂无匿称), createdTime=Sat Feb 18 21:45:49 CST 2017, time=2017-02-18, status=1, ipAttribution=)]
    2017-02-20 xxxx1054
  2. [GetPortalCommentsPageByObjectIdResponse(id=1549039, encodeId=ec0a154903953, content=<a href='/topic/show?id=f7879600061' target=_blank style='color:#2F92EE;'>#重磅#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96000, encryptionId=f7879600061, topicName=重磅)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3acc14121561, createdName=xxxx1054, createdTime=Mon Feb 20 12:06:00 CST 2017, time=2017-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=177098, encodeId=47221e709881, content=小编辛苦了,感谢为我们准备了绝佳的精神晚餐,给点赞了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Mon Feb 20 08:34:47 CST 2017, time=2017-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176984, encodeId=81a51e698438, content=好好努力, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Feb 19 15:03:30 CST 2017, time=2017-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176971, encodeId=8bc01e6971e3, content=文章真心不错耶, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sun Feb 19 14:00:01 CST 2017, time=2017-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176955, encodeId=ab291e69556b, content=学习了,有待临床进一步研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=387d1660055, createdName=dhzzm, createdTime=Sun Feb 19 12:02:17 CST 2017, time=2017-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176875, encodeId=175c1e6875aa, content=学习了,很前沿的知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Sat Feb 18 21:54:13 CST 2017, time=2017-02-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176874, encodeId=2b8e1e68745d, content=这个软件超好, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=53111694095, createdName=1de65cf8m77(暂无匿称), createdTime=Sat Feb 18 21:45:49 CST 2017, time=2017-02-18, status=1, ipAttribution=)]
    2017-02-20 ylzr123

    小编辛苦了,感谢为我们准备了绝佳的精神晚餐,给点赞了!

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1549039, encodeId=ec0a154903953, content=<a href='/topic/show?id=f7879600061' target=_blank style='color:#2F92EE;'>#重磅#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96000, encryptionId=f7879600061, topicName=重磅)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3acc14121561, createdName=xxxx1054, createdTime=Mon Feb 20 12:06:00 CST 2017, time=2017-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=177098, encodeId=47221e709881, content=小编辛苦了,感谢为我们准备了绝佳的精神晚餐,给点赞了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Mon Feb 20 08:34:47 CST 2017, time=2017-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176984, encodeId=81a51e698438, content=好好努力, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Feb 19 15:03:30 CST 2017, time=2017-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176971, encodeId=8bc01e6971e3, content=文章真心不错耶, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sun Feb 19 14:00:01 CST 2017, time=2017-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176955, encodeId=ab291e69556b, content=学习了,有待临床进一步研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=387d1660055, createdName=dhzzm, createdTime=Sun Feb 19 12:02:17 CST 2017, time=2017-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176875, encodeId=175c1e6875aa, content=学习了,很前沿的知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Sat Feb 18 21:54:13 CST 2017, time=2017-02-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176874, encodeId=2b8e1e68745d, content=这个软件超好, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=53111694095, createdName=1de65cf8m77(暂无匿称), createdTime=Sat Feb 18 21:45:49 CST 2017, time=2017-02-18, status=1, ipAttribution=)]
    2017-02-19 忠诚向上

    好好努力

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1549039, encodeId=ec0a154903953, content=<a href='/topic/show?id=f7879600061' target=_blank style='color:#2F92EE;'>#重磅#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96000, encryptionId=f7879600061, topicName=重磅)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3acc14121561, createdName=xxxx1054, createdTime=Mon Feb 20 12:06:00 CST 2017, time=2017-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=177098, encodeId=47221e709881, content=小编辛苦了,感谢为我们准备了绝佳的精神晚餐,给点赞了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Mon Feb 20 08:34:47 CST 2017, time=2017-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176984, encodeId=81a51e698438, content=好好努力, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Feb 19 15:03:30 CST 2017, time=2017-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176971, encodeId=8bc01e6971e3, content=文章真心不错耶, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sun Feb 19 14:00:01 CST 2017, time=2017-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176955, encodeId=ab291e69556b, content=学习了,有待临床进一步研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=387d1660055, createdName=dhzzm, createdTime=Sun Feb 19 12:02:17 CST 2017, time=2017-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176875, encodeId=175c1e6875aa, content=学习了,很前沿的知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Sat Feb 18 21:54:13 CST 2017, time=2017-02-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176874, encodeId=2b8e1e68745d, content=这个软件超好, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=53111694095, createdName=1de65cf8m77(暂无匿称), createdTime=Sat Feb 18 21:45:49 CST 2017, time=2017-02-18, status=1, ipAttribution=)]
    2017-02-19 1e10c84am36(暂无匿称)

    文章真心不错耶

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1549039, encodeId=ec0a154903953, content=<a href='/topic/show?id=f7879600061' target=_blank style='color:#2F92EE;'>#重磅#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96000, encryptionId=f7879600061, topicName=重磅)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3acc14121561, createdName=xxxx1054, createdTime=Mon Feb 20 12:06:00 CST 2017, time=2017-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=177098, encodeId=47221e709881, content=小编辛苦了,感谢为我们准备了绝佳的精神晚餐,给点赞了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Mon Feb 20 08:34:47 CST 2017, time=2017-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176984, encodeId=81a51e698438, content=好好努力, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Feb 19 15:03:30 CST 2017, time=2017-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176971, encodeId=8bc01e6971e3, content=文章真心不错耶, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sun Feb 19 14:00:01 CST 2017, time=2017-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176955, encodeId=ab291e69556b, content=学习了,有待临床进一步研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=387d1660055, createdName=dhzzm, createdTime=Sun Feb 19 12:02:17 CST 2017, time=2017-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176875, encodeId=175c1e6875aa, content=学习了,很前沿的知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Sat Feb 18 21:54:13 CST 2017, time=2017-02-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176874, encodeId=2b8e1e68745d, content=这个软件超好, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=53111694095, createdName=1de65cf8m77(暂无匿称), createdTime=Sat Feb 18 21:45:49 CST 2017, time=2017-02-18, status=1, ipAttribution=)]
    2017-02-19 dhzzm

    学习了,有待临床进一步研究

    0

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    2017-02-18 有备才能无患

    学习了,很前沿的知识

    0

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    2017-02-18 1de65cf8m77(暂无匿称)

    这个软件超好

    0

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