超实用!大咖把脉:我们应该如何设计肺炎临床研究?

2018-04-21 邢英 中国医学论坛报

4月20-22日,由中华医学会《中华医学杂志英文版》、中华医学会呼吸病学分会青年委员会共同主办,浙江大学呼吸疾病研究所承办的第十五届中青年呼吸学者论坛,在浙江省杭州市召开。本届论坛由王辰院士和陈荣昌主委担任主席,执行主席为应颂敏教授。同时,本届论坛的会前会安排了“临床科研选题设计”培训,为中青年医生科研能力的成长助力。

4月20-22日,由中华医学会《中华医学杂志英文版》、中华医学会呼吸病学分会青年委员会共同主办,浙江大学呼吸疾病研究所承办的第十五届中青年呼吸学者论坛,在浙江省杭州市召开。本届论坛由王辰院士和陈荣昌主委担任主席,执行主席为应颂敏教授。同时,本届论坛的会前会安排了“临床科研选题设计”培训,为中青年医生科研能力的成长助力。

讲者:中日医院呼吸与危重症医学科 呼吸疾病国家临床研究中心 曹彬 教授 

肺炎临床需要解决的科学问题

肺炎是世界范围内多发而严重的感染性疾病,也是全球最主要死因和首位感染性疾病死因。然而,目前国内尚缺乏成人肺炎发病率、肺炎远期预后的调查数据。相关指南中未纳入免疫缺陷、血液系统肿瘤、器官移植、接受糖皮质激素治疗等罹患肺炎的患者,而在我们实际临床工作之中,我们恰恰需要帮助这部分患者。因此,应将具有高危宿主因素这部分肺炎患者纳入到临床研究中来。

在肺炎严重程度评价方面,以肺炎严重度指数(PSI)和CURB-65评分应用最为广泛,但日本呼吸病学会并没有直接照搬欧美PSI评分和CURB-65评分,而是在CURB-65的基础上结合自身国情,提出了A-DROP评分。相比CURB-65评分,长寿的日本人把年龄界限提高到了男性70岁,女性75岁。不管是欧美,还是日本,都很注重年龄因素在病情严重程度评价中的作用。目前,中国预期寿命是73岁,我们是否应该拥有自己国家的病情严重程度评价标准?

针对肺炎病原体的治疗,我们有很多药物,如,头孢菌素类、碳青霉烯类抗生素、大环内酯类药物、喹诺酮类、氨基糖苷类、抗结核药、抗真菌药等。然而,由中国学者牵头针对中国人群抗肺炎治疗的随机对照研究少之又少。而且,目前肺炎治疗,仅仅是针对病原菌进行干预,而并未针对宿主进行治疗。同样,在肺炎预防领域,我们依然缺乏疫苗接种后相关数据。

此外,很多年轻科研工作者可能会闯入这样的误区,研究设计不够重视或不严谨、不科学,等到收集数据时,才发现拉下某些数据,致使证据链不充分,甚至拿到一堆垃圾数据。因此,关于肺炎研究,应反复论证科学设计,课题实施过程中应严格进行质量控制。 

肺炎临床研究:从临床表型到内型深化

仔细去梳理,我们可以发现,肺炎具有高度的异质性。我们简单将肺炎分成社区获得性肺炎(CAP)、医院获得性肺炎(HAP),实在是难以满足肺炎患者诊断和治疗的需要。换言之,CAP和HAP指南并不适用于所有人群。面对80岁男性、肺癌、慢阻肺、化疗、应用激素等肺炎患者,患者病原学特征、治疗证据是缺失的。这常常是我们面临的困难。

特别对肺炎感兴趣的医生建议,可以参照哮喘、慢阻肺研究思路,将患者进行分组、分层。目前肺炎相关研究,更多是局限在症状、实验室检查、影像学特点来进行分型,但是真正代表患者病理生理机制、功能变化的研究,少之又少。我们应该对肺炎的认识,从表型到内型逐步深入。 

肺炎研究未来三大方向

当前我国肺炎研究偏重病原学调查,偏重疾病临床特征描述。这些很重要,但并非是高水平、高层次的研究。近日,美国国立心脏、肺和血液学研究所(NHLBI)工作组报告发布了肺炎研究未来方向,其中涉及到宿主易感性(慢性疾病、年龄、易感基因、暴露因素),致病微生物侵袭、毒力、粘附性、耐药,肺外脏器功能影响、宿主结局、远期预后都是未来主要研究方向。总体上,非常宏观,但缺少具体实施路线。

仔细梳理一下,也就是三大方向,需要好好布局。

第一,肺炎宿主基因易感性。

2005年,一项综述对肺炎宿主基因易感性进行了阐释,涉及到模式识别分子(PRMs)以及MBL、Toll样受体、CD14等,ACE多态性,炎症及抗炎反应过程[Semin Respir Crit Care Med 2005 ,26(6):553]。但自此之后,跟进研究非常少。2013年,北京佑安医院和英国牛津大学联合研究发现,轻度、重度H1N1流感患者临床基线特征比较,存在显著差异。基因多态性进行分析,IFITM3 rs12252中的CC、CT及TT基因型在轻度、重度流感患者中分布不同,携带CC基因型是发生重症流感感染的危险因素。2017年,我国学者研究发现, IFITM3 rs12252与TLR3 rs5743313多态性与流感患者死亡相关,还与流感肺炎死亡和呼吸衰竭相关,出现两种基因多态性的人群远期生存率显著降低。2018年,南京军区总医院苏欣教授团队发表在《感染病学杂志》(clin infect dis)研究显示,PTX3 rs1840680多态性与慢阻肺患者易感曲霉菌病相关,PTX3可能是预测慢阻肺患者是否患侵入性肺曲霉病的生物标志物[Clin Infect Dis 2018,66(2):261]。

第二,肺炎感染后宿主与病原体的反应。

最近国际上有几项研究值得我们借鉴。一项研究针对6个不同研究人群(SIRS),通过RNA芯片鉴别是否存在感染和何种类型感染:是细菌,还是病毒,还是混合病原体感染?其理论依据是主要是基于不同病原体与宿主作用,炎症反应不一样。通过弃一交叉法验证人群中细菌、病毒及非感染性疾病的分布,以0.5为阈值,可有助于我们鉴别细菌、病毒及病毒-细菌共感染。

此外,目前已经有一些研究,通过抗感染药物与针对宿主反应的联合治疗评价治疗效果。浙二医徐峰教授团队研究(投稿中)显示,阿司匹林与大环内酯类联用可降低重症CAP的死亡率,联用效果优于大环内酯类单用。实际上,该研究中大环内酯类药物不是作为抗菌药物,而是作为免疫调节药物,而且联合用药最常用阿司匹林。另一项关于住院H3N2患者研究显示,大环内酯类抗生素+非类固醇抗炎药+奥司他韦联用组30天死亡率,较奥司他韦单药组明显改善。当然,目前这些研究仅仅是处于起步阶段,尚未画上圆满的句号,仍有待于我们努力开展研究。

第三,肺炎后全身反应以及远期预后。

关于肺炎后全身反应以及远期预后,国内研究非常少。值得大家注意的是,肺炎住院期间发热可能降下来了,但是炎症反应仍旧存在,而且这种炎症反应对全身影响是长期存在的,因此,我们应该特别关注患者远期预后。CAP-China肺炎远期预后研究显示,CAP患者的远期生存率低于普通人群,尤其是老年和伴有慢性疾病患者,年龄和合并慢性疾病是影响CAP患者远期死亡率的独立危险因素。

最后,对于住院医生,写大病例,诊断出社区获得性肺炎就合格了,但对于肺炎研究者来说,就是不合格的。我们要考如下因素:虑临床表现多样性、宿主易感因素多样性、致病微生物多样性、干预药物反应状况、药理多样性、炎症反应多样性等。此外,进行严肃的、有使命感、负责任的肺炎研究,也是我们的梦想!

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (11)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=881659, encodeId=4875881659fd, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=64245268311, createdName=14818eb4m67暂无昵称, createdTime=Tue Sep 01 08:13:03 CST 2020, time=2020-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1758578, encodeId=e6c41e58578d4, content=<a href='/topic/show?id=9aab549134b' target=_blank style='color:#2F92EE;'>#把脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54913, encryptionId=9aab549134b, topicName=把脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a1dc37340209, createdName=ms2186806800017884, createdTime=Sat Feb 09 10:43:00 CST 2019, time=2019-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=311483, encodeId=f300311483b7, content=学习了 非常感谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a35e76003, createdName=871538379, createdTime=Thu May 03 05:41:25 CST 2018, time=2018-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309319, encodeId=0ea3309319df, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a8f22260741, createdName=121832a9m88暂无昵称, createdTime=Thu Apr 26 05:48:55 CST 2018, time=2018-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308218, encodeId=c77430821852, content=学习.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, createdTime=Sun Apr 22 12:11:12 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308111, encodeId=0b2c308111d3, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Sun Apr 22 06:47:32 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308110, encodeId=be3d3081100d, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Sun Apr 22 06:47:02 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308053, encodeId=9844308053d1, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/01/15/8213228fe923915543544ad3da7e1c64.jpg, createdBy=6bd82014262, createdName=秀红, createdTime=Sun Apr 22 00:50:50 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308046, encodeId=cca43080468f, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/2EVCwc9WmQS6ec99H2TX8ejmR40xYjwrIcrqjAnibV36aicL1sLxc21rhpZnqTOxk33HP44iayEwo6qYXqgZvdRtA/132, createdBy=d0d01573846, createdName=329523732, createdTime=Sun Apr 22 00:31:28 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308039, encodeId=3a0a308039ad, content=阅, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/fhZdOu27e88Voqh19n8eF8cLplo8L4nicKtH0WnE3KFELXns5XDu8rsiceK2HHDZc2SEStia5VV3Pia2QLMVqlWbHw/0, createdBy=6e012139475, createdName=神功盖世, createdTime=Sun Apr 22 00:23:34 CST 2018, time=2018-04-22, status=1, ipAttribution=)]
    2020-09-01 14818eb4m67暂无昵称

    学习

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=881659, encodeId=4875881659fd, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=64245268311, createdName=14818eb4m67暂无昵称, createdTime=Tue Sep 01 08:13:03 CST 2020, time=2020-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1758578, encodeId=e6c41e58578d4, content=<a href='/topic/show?id=9aab549134b' target=_blank style='color:#2F92EE;'>#把脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54913, encryptionId=9aab549134b, topicName=把脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a1dc37340209, createdName=ms2186806800017884, createdTime=Sat Feb 09 10:43:00 CST 2019, time=2019-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=311483, encodeId=f300311483b7, content=学习了 非常感谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a35e76003, createdName=871538379, createdTime=Thu May 03 05:41:25 CST 2018, time=2018-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309319, encodeId=0ea3309319df, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a8f22260741, createdName=121832a9m88暂无昵称, createdTime=Thu Apr 26 05:48:55 CST 2018, time=2018-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308218, encodeId=c77430821852, content=学习.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, createdTime=Sun Apr 22 12:11:12 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308111, encodeId=0b2c308111d3, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Sun Apr 22 06:47:32 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308110, encodeId=be3d3081100d, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Sun Apr 22 06:47:02 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308053, encodeId=9844308053d1, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/01/15/8213228fe923915543544ad3da7e1c64.jpg, createdBy=6bd82014262, createdName=秀红, createdTime=Sun Apr 22 00:50:50 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308046, encodeId=cca43080468f, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/2EVCwc9WmQS6ec99H2TX8ejmR40xYjwrIcrqjAnibV36aicL1sLxc21rhpZnqTOxk33HP44iayEwo6qYXqgZvdRtA/132, createdBy=d0d01573846, createdName=329523732, createdTime=Sun Apr 22 00:31:28 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308039, encodeId=3a0a308039ad, content=阅, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/fhZdOu27e88Voqh19n8eF8cLplo8L4nicKtH0WnE3KFELXns5XDu8rsiceK2HHDZc2SEStia5VV3Pia2QLMVqlWbHw/0, createdBy=6e012139475, createdName=神功盖世, createdTime=Sun Apr 22 00:23:34 CST 2018, time=2018-04-22, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=881659, encodeId=4875881659fd, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=64245268311, createdName=14818eb4m67暂无昵称, createdTime=Tue Sep 01 08:13:03 CST 2020, time=2020-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1758578, encodeId=e6c41e58578d4, content=<a href='/topic/show?id=9aab549134b' target=_blank style='color:#2F92EE;'>#把脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54913, encryptionId=9aab549134b, topicName=把脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a1dc37340209, createdName=ms2186806800017884, createdTime=Sat Feb 09 10:43:00 CST 2019, time=2019-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=311483, encodeId=f300311483b7, content=学习了 非常感谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a35e76003, createdName=871538379, createdTime=Thu May 03 05:41:25 CST 2018, time=2018-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309319, encodeId=0ea3309319df, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a8f22260741, createdName=121832a9m88暂无昵称, createdTime=Thu Apr 26 05:48:55 CST 2018, time=2018-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308218, encodeId=c77430821852, content=学习.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, createdTime=Sun Apr 22 12:11:12 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308111, encodeId=0b2c308111d3, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Sun Apr 22 06:47:32 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308110, encodeId=be3d3081100d, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Sun Apr 22 06:47:02 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308053, encodeId=9844308053d1, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/01/15/8213228fe923915543544ad3da7e1c64.jpg, createdBy=6bd82014262, createdName=秀红, createdTime=Sun Apr 22 00:50:50 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308046, encodeId=cca43080468f, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/2EVCwc9WmQS6ec99H2TX8ejmR40xYjwrIcrqjAnibV36aicL1sLxc21rhpZnqTOxk33HP44iayEwo6qYXqgZvdRtA/132, createdBy=d0d01573846, createdName=329523732, createdTime=Sun Apr 22 00:31:28 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308039, encodeId=3a0a308039ad, content=阅, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/fhZdOu27e88Voqh19n8eF8cLplo8L4nicKtH0WnE3KFELXns5XDu8rsiceK2HHDZc2SEStia5VV3Pia2QLMVqlWbHw/0, createdBy=6e012139475, createdName=神功盖世, createdTime=Sun Apr 22 00:23:34 CST 2018, time=2018-04-22, status=1, ipAttribution=)]
    2018-05-03 871538379

    学习了 非常感谢

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=881659, encodeId=4875881659fd, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=64245268311, createdName=14818eb4m67暂无昵称, createdTime=Tue Sep 01 08:13:03 CST 2020, time=2020-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1758578, encodeId=e6c41e58578d4, content=<a href='/topic/show?id=9aab549134b' target=_blank style='color:#2F92EE;'>#把脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54913, encryptionId=9aab549134b, topicName=把脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a1dc37340209, createdName=ms2186806800017884, createdTime=Sat Feb 09 10:43:00 CST 2019, time=2019-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=311483, encodeId=f300311483b7, content=学习了 非常感谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a35e76003, createdName=871538379, createdTime=Thu May 03 05:41:25 CST 2018, time=2018-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309319, encodeId=0ea3309319df, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a8f22260741, createdName=121832a9m88暂无昵称, createdTime=Thu Apr 26 05:48:55 CST 2018, time=2018-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308218, encodeId=c77430821852, content=学习.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, createdTime=Sun Apr 22 12:11:12 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308111, encodeId=0b2c308111d3, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Sun Apr 22 06:47:32 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308110, encodeId=be3d3081100d, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Sun Apr 22 06:47:02 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308053, encodeId=9844308053d1, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/01/15/8213228fe923915543544ad3da7e1c64.jpg, createdBy=6bd82014262, createdName=秀红, createdTime=Sun Apr 22 00:50:50 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308046, encodeId=cca43080468f, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/2EVCwc9WmQS6ec99H2TX8ejmR40xYjwrIcrqjAnibV36aicL1sLxc21rhpZnqTOxk33HP44iayEwo6qYXqgZvdRtA/132, createdBy=d0d01573846, createdName=329523732, createdTime=Sun Apr 22 00:31:28 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308039, encodeId=3a0a308039ad, content=阅, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/fhZdOu27e88Voqh19n8eF8cLplo8L4nicKtH0WnE3KFELXns5XDu8rsiceK2HHDZc2SEStia5VV3Pia2QLMVqlWbHw/0, createdBy=6e012139475, createdName=神功盖世, createdTime=Sun Apr 22 00:23:34 CST 2018, time=2018-04-22, status=1, ipAttribution=)]
    2018-04-26 121832a9m88暂无昵称

    学习了

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=881659, encodeId=4875881659fd, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=64245268311, createdName=14818eb4m67暂无昵称, createdTime=Tue Sep 01 08:13:03 CST 2020, time=2020-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1758578, encodeId=e6c41e58578d4, content=<a href='/topic/show?id=9aab549134b' target=_blank style='color:#2F92EE;'>#把脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54913, encryptionId=9aab549134b, topicName=把脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a1dc37340209, createdName=ms2186806800017884, createdTime=Sat Feb 09 10:43:00 CST 2019, time=2019-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=311483, encodeId=f300311483b7, content=学习了 非常感谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a35e76003, createdName=871538379, createdTime=Thu May 03 05:41:25 CST 2018, time=2018-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309319, encodeId=0ea3309319df, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a8f22260741, createdName=121832a9m88暂无昵称, createdTime=Thu Apr 26 05:48:55 CST 2018, time=2018-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308218, encodeId=c77430821852, content=学习.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, createdTime=Sun Apr 22 12:11:12 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308111, encodeId=0b2c308111d3, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Sun Apr 22 06:47:32 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308110, encodeId=be3d3081100d, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Sun Apr 22 06:47:02 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308053, encodeId=9844308053d1, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/01/15/8213228fe923915543544ad3da7e1c64.jpg, createdBy=6bd82014262, createdName=秀红, createdTime=Sun Apr 22 00:50:50 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308046, encodeId=cca43080468f, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/2EVCwc9WmQS6ec99H2TX8ejmR40xYjwrIcrqjAnibV36aicL1sLxc21rhpZnqTOxk33HP44iayEwo6qYXqgZvdRtA/132, createdBy=d0d01573846, createdName=329523732, createdTime=Sun Apr 22 00:31:28 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308039, encodeId=3a0a308039ad, content=阅, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/fhZdOu27e88Voqh19n8eF8cLplo8L4nicKtH0WnE3KFELXns5XDu8rsiceK2HHDZc2SEStia5VV3Pia2QLMVqlWbHw/0, createdBy=6e012139475, createdName=神功盖世, createdTime=Sun Apr 22 00:23:34 CST 2018, time=2018-04-22, status=1, ipAttribution=)]
    2018-04-22 执着追梦

    学习.谢谢分享

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=881659, encodeId=4875881659fd, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=64245268311, createdName=14818eb4m67暂无昵称, createdTime=Tue Sep 01 08:13:03 CST 2020, time=2020-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1758578, encodeId=e6c41e58578d4, content=<a href='/topic/show?id=9aab549134b' target=_blank style='color:#2F92EE;'>#把脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54913, encryptionId=9aab549134b, topicName=把脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a1dc37340209, createdName=ms2186806800017884, createdTime=Sat Feb 09 10:43:00 CST 2019, time=2019-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=311483, encodeId=f300311483b7, content=学习了 非常感谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a35e76003, createdName=871538379, createdTime=Thu May 03 05:41:25 CST 2018, time=2018-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309319, encodeId=0ea3309319df, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a8f22260741, createdName=121832a9m88暂无昵称, createdTime=Thu Apr 26 05:48:55 CST 2018, time=2018-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308218, encodeId=c77430821852, content=学习.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, createdTime=Sun Apr 22 12:11:12 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308111, encodeId=0b2c308111d3, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Sun Apr 22 06:47:32 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308110, encodeId=be3d3081100d, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Sun Apr 22 06:47:02 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308053, encodeId=9844308053d1, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/01/15/8213228fe923915543544ad3da7e1c64.jpg, createdBy=6bd82014262, createdName=秀红, createdTime=Sun Apr 22 00:50:50 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308046, encodeId=cca43080468f, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/2EVCwc9WmQS6ec99H2TX8ejmR40xYjwrIcrqjAnibV36aicL1sLxc21rhpZnqTOxk33HP44iayEwo6qYXqgZvdRtA/132, createdBy=d0d01573846, createdName=329523732, createdTime=Sun Apr 22 00:31:28 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308039, encodeId=3a0a308039ad, content=阅, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/fhZdOu27e88Voqh19n8eF8cLplo8L4nicKtH0WnE3KFELXns5XDu8rsiceK2HHDZc2SEStia5VV3Pia2QLMVqlWbHw/0, createdBy=6e012139475, createdName=神功盖世, createdTime=Sun Apr 22 00:23:34 CST 2018, time=2018-04-22, status=1, ipAttribution=)]
    2018-04-22 张新亮1853311252142e2fm

    好文献学习了

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=881659, encodeId=4875881659fd, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=64245268311, createdName=14818eb4m67暂无昵称, createdTime=Tue Sep 01 08:13:03 CST 2020, time=2020-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1758578, encodeId=e6c41e58578d4, content=<a href='/topic/show?id=9aab549134b' target=_blank style='color:#2F92EE;'>#把脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54913, encryptionId=9aab549134b, topicName=把脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a1dc37340209, createdName=ms2186806800017884, createdTime=Sat Feb 09 10:43:00 CST 2019, time=2019-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=311483, encodeId=f300311483b7, content=学习了 非常感谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a35e76003, createdName=871538379, createdTime=Thu May 03 05:41:25 CST 2018, time=2018-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309319, encodeId=0ea3309319df, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a8f22260741, createdName=121832a9m88暂无昵称, createdTime=Thu Apr 26 05:48:55 CST 2018, time=2018-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308218, encodeId=c77430821852, content=学习.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, createdTime=Sun Apr 22 12:11:12 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308111, encodeId=0b2c308111d3, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Sun Apr 22 06:47:32 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308110, encodeId=be3d3081100d, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Sun Apr 22 06:47:02 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308053, encodeId=9844308053d1, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/01/15/8213228fe923915543544ad3da7e1c64.jpg, createdBy=6bd82014262, createdName=秀红, createdTime=Sun Apr 22 00:50:50 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308046, encodeId=cca43080468f, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/2EVCwc9WmQS6ec99H2TX8ejmR40xYjwrIcrqjAnibV36aicL1sLxc21rhpZnqTOxk33HP44iayEwo6qYXqgZvdRtA/132, createdBy=d0d01573846, createdName=329523732, createdTime=Sun Apr 22 00:31:28 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308039, encodeId=3a0a308039ad, content=阅, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/fhZdOu27e88Voqh19n8eF8cLplo8L4nicKtH0WnE3KFELXns5XDu8rsiceK2HHDZc2SEStia5VV3Pia2QLMVqlWbHw/0, createdBy=6e012139475, createdName=神功盖世, createdTime=Sun Apr 22 00:23:34 CST 2018, time=2018-04-22, status=1, ipAttribution=)]
    2018-04-22 张新亮1853311252142e2fm

    好文献学习了

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=881659, encodeId=4875881659fd, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=64245268311, createdName=14818eb4m67暂无昵称, createdTime=Tue Sep 01 08:13:03 CST 2020, time=2020-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1758578, encodeId=e6c41e58578d4, content=<a href='/topic/show?id=9aab549134b' target=_blank style='color:#2F92EE;'>#把脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54913, encryptionId=9aab549134b, topicName=把脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a1dc37340209, createdName=ms2186806800017884, createdTime=Sat Feb 09 10:43:00 CST 2019, time=2019-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=311483, encodeId=f300311483b7, content=学习了 非常感谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a35e76003, createdName=871538379, createdTime=Thu May 03 05:41:25 CST 2018, time=2018-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309319, encodeId=0ea3309319df, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a8f22260741, createdName=121832a9m88暂无昵称, createdTime=Thu Apr 26 05:48:55 CST 2018, time=2018-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308218, encodeId=c77430821852, content=学习.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, createdTime=Sun Apr 22 12:11:12 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308111, encodeId=0b2c308111d3, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Sun Apr 22 06:47:32 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308110, encodeId=be3d3081100d, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Sun Apr 22 06:47:02 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308053, encodeId=9844308053d1, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/01/15/8213228fe923915543544ad3da7e1c64.jpg, createdBy=6bd82014262, createdName=秀红, createdTime=Sun Apr 22 00:50:50 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308046, encodeId=cca43080468f, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/2EVCwc9WmQS6ec99H2TX8ejmR40xYjwrIcrqjAnibV36aicL1sLxc21rhpZnqTOxk33HP44iayEwo6qYXqgZvdRtA/132, createdBy=d0d01573846, createdName=329523732, createdTime=Sun Apr 22 00:31:28 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308039, encodeId=3a0a308039ad, content=阅, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/fhZdOu27e88Voqh19n8eF8cLplo8L4nicKtH0WnE3KFELXns5XDu8rsiceK2HHDZc2SEStia5VV3Pia2QLMVqlWbHw/0, createdBy=6e012139475, createdName=神功盖世, createdTime=Sun Apr 22 00:23:34 CST 2018, time=2018-04-22, status=1, ipAttribution=)]
    2018-04-22 秀红

    学习了

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=881659, encodeId=4875881659fd, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=64245268311, createdName=14818eb4m67暂无昵称, createdTime=Tue Sep 01 08:13:03 CST 2020, time=2020-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1758578, encodeId=e6c41e58578d4, content=<a href='/topic/show?id=9aab549134b' target=_blank style='color:#2F92EE;'>#把脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54913, encryptionId=9aab549134b, topicName=把脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a1dc37340209, createdName=ms2186806800017884, createdTime=Sat Feb 09 10:43:00 CST 2019, time=2019-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=311483, encodeId=f300311483b7, content=学习了 非常感谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a35e76003, createdName=871538379, createdTime=Thu May 03 05:41:25 CST 2018, time=2018-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309319, encodeId=0ea3309319df, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a8f22260741, createdName=121832a9m88暂无昵称, createdTime=Thu Apr 26 05:48:55 CST 2018, time=2018-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308218, encodeId=c77430821852, content=学习.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, createdTime=Sun Apr 22 12:11:12 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308111, encodeId=0b2c308111d3, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Sun Apr 22 06:47:32 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308110, encodeId=be3d3081100d, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Sun Apr 22 06:47:02 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308053, encodeId=9844308053d1, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/01/15/8213228fe923915543544ad3da7e1c64.jpg, createdBy=6bd82014262, createdName=秀红, createdTime=Sun Apr 22 00:50:50 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308046, encodeId=cca43080468f, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/2EVCwc9WmQS6ec99H2TX8ejmR40xYjwrIcrqjAnibV36aicL1sLxc21rhpZnqTOxk33HP44iayEwo6qYXqgZvdRtA/132, createdBy=d0d01573846, createdName=329523732, createdTime=Sun Apr 22 00:31:28 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308039, encodeId=3a0a308039ad, content=阅, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/fhZdOu27e88Voqh19n8eF8cLplo8L4nicKtH0WnE3KFELXns5XDu8rsiceK2HHDZc2SEStia5VV3Pia2QLMVqlWbHw/0, createdBy=6e012139475, createdName=神功盖世, createdTime=Sun Apr 22 00:23:34 CST 2018, time=2018-04-22, status=1, ipAttribution=)]
    2018-04-22 329523732

    不错

    0

  10. [GetPortalCommentsPageByObjectIdResponse(id=881659, encodeId=4875881659fd, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=64245268311, createdName=14818eb4m67暂无昵称, createdTime=Tue Sep 01 08:13:03 CST 2020, time=2020-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1758578, encodeId=e6c41e58578d4, content=<a href='/topic/show?id=9aab549134b' target=_blank style='color:#2F92EE;'>#把脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54913, encryptionId=9aab549134b, topicName=把脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a1dc37340209, createdName=ms2186806800017884, createdTime=Sat Feb 09 10:43:00 CST 2019, time=2019-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=311483, encodeId=f300311483b7, content=学习了 非常感谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a35e76003, createdName=871538379, createdTime=Thu May 03 05:41:25 CST 2018, time=2018-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=309319, encodeId=0ea3309319df, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a8f22260741, createdName=121832a9m88暂无昵称, createdTime=Thu Apr 26 05:48:55 CST 2018, time=2018-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308218, encodeId=c77430821852, content=学习.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyhb9xDeHojCicsdRdyC3XXdGk2ib9yLypZuHN06WeW4HO8WN0GGrgEfvnTX8gsckof05GHOU5OM4Mvx/0, createdBy=9cee1982656, createdName=执着追梦, createdTime=Sun Apr 22 12:11:12 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308111, encodeId=0b2c308111d3, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Sun Apr 22 06:47:32 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308110, encodeId=be3d3081100d, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Sun Apr 22 06:47:02 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308053, encodeId=9844308053d1, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/01/15/8213228fe923915543544ad3da7e1c64.jpg, createdBy=6bd82014262, createdName=秀红, createdTime=Sun Apr 22 00:50:50 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308046, encodeId=cca43080468f, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/2EVCwc9WmQS6ec99H2TX8ejmR40xYjwrIcrqjAnibV36aicL1sLxc21rhpZnqTOxk33HP44iayEwo6qYXqgZvdRtA/132, createdBy=d0d01573846, createdName=329523732, createdTime=Sun Apr 22 00:31:28 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308039, encodeId=3a0a308039ad, content=阅, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/fhZdOu27e88Voqh19n8eF8cLplo8L4nicKtH0WnE3KFELXns5XDu8rsiceK2HHDZc2SEStia5VV3Pia2QLMVqlWbHw/0, createdBy=6e012139475, createdName=神功盖世, createdTime=Sun Apr 22 00:23:34 CST 2018, time=2018-04-22, status=1, ipAttribution=)]
    2018-04-22 神功盖世

    0

相关资讯

病例:抽丝剥茧,他是肺炎链球菌肺炎吗?

患儿男性,16个月,因“咳嗽1周,发热2天”入院。

Lancet Public Health:禁烟使儿童肺炎入院率降低18.5%,重度哮喘发作减少9.8%,早产儿减少3.7%

英国爱丁堡大学与荷兰伊拉斯姆斯大学医学中心的学者在Lancet Public Health上发表的系统回顾和荟萃分析结果显示,实施世界卫生组织烟草控制框架公约为全球签署国家的儿童健康带来了显著的好处。

BMJ:上腹部手术后物理治疗可降低肺并发症风险

研究认为,对于上腹部手术患者,术后接受30分钟物理治疗可显著降低肺并发症风险

Stem cells:TLR4-PAR1轴调控实验性细菌性肺炎的骨髓间充质干细胞的存活和治疗作用

现已发现骨髓来源的间充质干细胞在肺炎和肺损伤的实验模型中具有重要的治疗作用。Naceen Gupta等人对Toll样受体4(TLR4)和蛋白激酶激活受体1(PAR1)通路对间充质干细胞(MSC)在肺炎的小鼠模型中存活和治疗活性的作用进行研究。分离来源于TLR4-/-和R41Q-PAR1突变小鼠的MSCs,检测突变的特异性通路,在体外细胞毒性刺激下,对MSC存活情况的影响。此外,并利用一大肠杆菌肺炎

J Clin Periodontol:血液透析患者牙周病与肺炎死亡率的7年队列研究

评估血液透析患者牙周病与肺炎死亡率的关系。