CDS今日重磅发布指南——《中国2型糖尿病防治指南(2020年版)》

2021-04-19 网络 网络

《中国2型糖尿病防治指南(2020年版)》(新版指南)正式发布!

《中国2型糖尿病防治指南(2020年版)》(新版指南)现已正式发布!新版指南于2021年4月在《中华糖尿病杂志》和《中华内分泌代谢杂志》同步发表。

本指南共19章,内容涵盖中国糖尿病流行病学、糖尿病的诊断与分型、2型糖尿病的三级预防、糖尿病的筛查和评估、糖尿病的教育和管理、2型糖尿病综合控制目标和高血糖的治疗路径、医学营养、运动治疗和体重管理、高血糖的药物治疗、糖尿病相关技术、糖尿病急性和慢性并发症、低血糖、糖尿病的特殊情况、代谢综合征和糖尿病的中医药治疗等。

更新要点一

最新流调数据显示, 糖尿病患病率11.2%(WHO标准)。

要点提示

1.我国糖尿病患病率仍在上升,2015至2017年达到11.2%,各民族有较大差异,各地区之间也存在差异。

2. 糖尿病的知晓率(36.5%)、治疗率(32.2%)和控制率(49.2%)有所改善,但仍处于低水平。

3.糖尿病人群中T2DM占90%以上。

更新要点二

糖化血红蛋白(HbA1c ) 纳入糖尿病诊断标准。

要点提示

1.空腹血糖、随机血糖或OGTT 2 h血糖是诊断糖尿病的主要依据,没有糖尿病典型临床症状时必须重复检测以确认诊断。(A)

2.在有严格质量控制的实验室,采用标准化检测方法测定的HbA1c 可以作为糖尿病的补充诊断标准。(B)

3.按病因将糖尿病分为T1DM、T2DM、特殊类型糖尿病和妊娠期糖尿病4种类型。(A)

更新要点三

综合控制目标部分,新增个体化HbA1c 控制目标设定的主要影响因素。

要点提示

1.T2DM的治疗策略应该是综合性的,包括血糖、血压、血脂、体重的控制,抗血小板治疗和改善生活方式等措施。(A)

2.对大多数非妊娠成年T2DM 患者,合理的HbA1c 控制目标为<7%。(A)

3.HbA1c 控制目标应遵循个体化原则,年龄较轻、病程较短、预期寿命较长、无并发症、未合并血管疾病的T2DM患者在没有低血糖及其他不良反应的情况下可采取更严格的HbA1c 控制目标,反之则采取相对宽松的HbA1c 目标。(B)

4.生活方式干预和二甲双胍为T2DM患者高血糖的一线治疗;生活方式干预是T2DM的基础治疗措施,应贯穿于治疗的始终;若无禁忌证,二甲双胍应一直保留在糖尿病的药物治疗方案中。(A)

5.一种降糖药治疗血糖不达标者,应采用2种甚至3种不同作用机制的药物联合治疗,也可加用胰岛素治疗。(A)

6.合并ASCVD或心血管风险高危的T2DM患者,不论其HbA1c 是否达标,只要没有禁忌证都应在二甲双胍的基础上加用具有ASCVD获益证据的GLP‑1RA或SGLT2i。(A)

7.合并CKD 或心力衰竭的T2DM 患者,不论其HbA1c 是否达标,只要没有禁忌证都应在二甲双胍的基础上加用SGLT2i;合并CKD的T2DM患者,如不能使用SGLT2i 可考虑选用GLP‑1RA。(A)

更新要点四

糖尿病的医学营养治疗部分添加每日能量供给量表格。

要点提示

1. T2DM 及糖尿病前期患者均需要接受个体化医学营养治疗,由熟悉糖尿病医学营养治疗的营养(医)师或综合管理团队(包括糖尿病教育者)指导患者完成。(A)

2.应在评估患者营养状况的基础上,设定合理的医学营养治疗目标和计划,控制总能量的摄入,合理、均衡分配各种营养素,达到患者的代谢控制目标,并尽可能满足个体饮食喜好。(B)

更新要点五

高血糖的治疗要点。

要点提示

1.二甲双胍为T2DM患者控制高血糖的一线用药和药物联合中的基本用药。(A)

2.磺脲类药物、格列奈类药物、α‑糖苷酶抑制剂、TZD、DPP‑4i、SGLT2i、GLP‑1RA和胰岛素是主要联合用药。(B)

3. T2DM 患者HbA1c 不达标时可根据低血糖风险、体重、经济条件、药物可及性等因素选择联用药物。(A)

4. 无论HbA1c 水平是否达标,T2DM 患者合并ASCVD、ASCVD高风险、心力衰竭或慢性肾脏病,建议首先联合有心血管疾病和慢性肾脏病获益证据的GLP‑1RA或SGLT2i。(A)

5. T2DM 患者在生活方式和口服降糖药联合治疗的基础上,若血糖仍未达到控制目标,尽早(3个月)开始胰岛素治疗。(A)

6. T2DM 患者的胰岛素起始治疗可以采用每日1~2次胰岛素。(A)

7. 对于HbA1c ≥9.0% 或空腹血糖≥11.1 mmol/L 同时伴明显高血糖症状的新诊断T2DM患者可考虑实施短期(2 周至3 个月)胰岛素强化治疗。(A)

8.胰岛素强化治疗可以采用每天2~4次注射或CSII方法。(A)

9. T2DM 患者采用餐时+基础胰岛素(4 次/d)与每日3次预混胰岛素类似物治疗的降糖疗效和安全性相似。(A)

10.在糖尿病病程中(包括新诊断的T2DM),出现无明显诱因的体重显著下降时,应该尽早使用胰岛素治疗。(A)

更新要点六

糖尿病治疗路径更新。

如血糖控制不达标(HbA1c ≥7%)则进入下一步治疗。

更新要点七

新添章节:2型糖尿病患者的体重管理。

要点提示

1. 超重和肥胖成人T2DM患者的管理目标为减轻体重5%~10%。(A)

2. 超重和肥胖成人T2DM患者的体重管理方式包 括 生 活 方 式 干 预 、药 物 、手 术 等 综 合 手段。(A)

3. 肥胖的成人T2DM 患者尽量采用生活方式及药物治疗,血糖仍然控制不佳者建议代谢手术治疗。(B)

4.代谢手术需要多学科协作,进行术前、术中及术后的全程管理。(C)

5. 代谢手术后患者应定期监测微量营养素和评估营养状态。(C)

更新要点八

血糖监测章节,TIR纳入血糖控制目标。

要点提示

1.血糖监测是糖尿病管理中的重要组成部分,其结果有助于评估糖尿病患者糖代谢紊乱的程度,制定合理的降糖方案,反映降糖治疗的效果并指导治疗方案的调整。(A)

2.临床上血糖监测方法包括毛细血管血糖监测、CGM、HbA 1c 和GA。(A)

3. TIR应纳入血糖控制目标。(B)

更新要点九

更新CKD进展风险及就诊频率。

要点提示

1.推荐所有 T2DM 患者每年至少进行1次UACR和血肌酐测定(计算eGFR)。(B)

2.有效的降糖治疗、血压控制可延缓糖尿病肾病的发生和进展。(A)

3.对 糖 尿 病 伴 高 血 压 且 UACR>300 mg/g 或eGFR<60 ml·min⁻¹·(1.73 m²)⁻¹的糖尿病患者,首选ACEI或ARB类药物治疗。(A)

4.对伴高血压且 UACR 为 30~300 mg/g 的糖尿病患者,推荐首选ACEI或ARB类药物治疗。(B)

5.对伴糖尿病肾病的 T2DM 患者,推荐在 eGFR≥45 ml·min ⁻ ¹·(1.73 m²)⁻ ¹ 的 患 者 中 使 用SGLT2i,以降低糖尿病肾病进展和(或)心血管事件的风险。(A)

6. 使用 GLP⁃1RA 能够降低新发大量白蛋白尿的风险,可考虑在eGFR≥30 ml·min⁻¹·(1.73 m²)⁻¹的患者中使用。(C)

7.推荐糖尿病肾病患者蛋白摄入量为0.8 g·kg⁻¹·d⁻¹,开始透析者蛋白摄入量可适当增加。(B)

8. 对 eGFR<30 ml·min⁻¹·(1.73 m²)⁻¹的糖尿病肾病患者,应由肾脏科医师评估是否应当接受肾脏替代治疗。(A)

更新要点十

低血糖分级。

要点提示

1、低血糖分级。

1级低血糖:血糖<3.9 mmol/L且≥3.0 mmol/L

2级低血糖:血糖<3.0 mmol/L

3级低血糖:没有特定血糖界限,伴有意识和(或)躯体改变的严重事件,需要他人帮助的低血糖。

2. 有低血糖风险的患者每次就诊时应询问有无低血糖症状。(C)

3. 使用有低血糖风险的降糖药治疗的患者应评估、筛查无症状性低血糖。(C)

4. 糖尿病患者如发生低血糖,应给予 15~20 g 葡萄糖并于15 min后检测血糖。(B)

5. 胰岛素治疗的患者如发生无症状性低血糖或1次3级低血糖或无诱因的2级低血糖,应放宽血糖控制目标,在数周内严格避免低血糖以部分逆转无症状性低血糖并降低未来低血糖风险。(A)

其他更新要点

✔糖尿病相关技术部分新添注射技术和胰岛素泵。

✔糖尿病视网膜病变(DR)章节部分加入人工智能(AI)在DR的筛查和分级诊断的作用,AI筛查系统有望成为DR筛查、诊断、随访的重要辅助工具。

关于新版指南

《中国2型糖尿病防治指南》于2003年首次发表,并于2007、2010、2013和2017年进行了4次修订。近年来,国内外2型糖尿病的研究取得了诸多重大进展,特别是发现了一些既能够降低血糖又具有心血管和肾脏保护作用的降糖药物,许多大型临床试验的良好结果使得人们对糖尿病及其相关并发症的治疗理念和行为发生了重大转变。在国际上诊断和治疗糖尿病的新方法、新技术和新证据不断涌现的同时,我国在糖尿病领域的研究也取得了很大进展,获得了更多的关于糖尿病及其慢性并发症预防、诊断、监测及治疗的循证医学新证据。 中华医学会糖尿病学分会组织专家对我国的2型糖尿病防治指南进行了再次修订,新版指南于2021年4月于《中华糖尿病杂志》和《中华内分泌代谢杂志》同步发表。

《中国2型糖尿病防治指南(2020年版)》凝聚了国内近百位专家的智慧和心血,依据国内外糖尿病研究的最新成果并立足于我国国情,具有很强的可操作性,充分体现了权威性、创新性、科学性、先进性和实用性的特色,必将对提高和规范我国T2DM的诊疗水平发挥积极的作用。

指南链接:中国 2型糖尿病防治指南(2020年版)

来源:综合整理自中华糖尿病杂志、中国医学论坛报今日糖尿病

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18:26:04 CST 2022, time=2022-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=999320, encodeId=1fb599932040, content=接受新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e5005540453, createdName=willing123, createdTime=Wed Jul 14 10:39:47 CST 2021, time=2021-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=960377, encodeId=884a9603e7c0, content=好好好, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e39e5226547, createdName=1478fcfem77暂无昵称, createdTime=Sun Apr 25 15:09:30 CST 2021, time=2021-04-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=958890, encodeId=8a08958890d3, content=很好,值得学习,怎么收藏呢, 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1549686, encodeId=903c1549686bd, content=<a href='/topic/show?id=f7879600061' target=_blank style='color:#2F92EE;'>#重磅#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, 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=Wed Apr 21 09:37:46 CST 2021, time=2021-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=958862, encodeId=b16f958862f0, content=收藏学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210125/9e5998de75824d5f8a8e76ad7ca79433/206fffa392c54ae5a60152c166e2f362.jpg, createdBy=ab0d5455599, createdName=二爽, createdTime=Tue Apr 20 20:33:27 CST 2021, time=2021-04-20, status=1, ipAttribution=)]
    2022-01-09 屋顶瞄爱赏月

    学习了

    0

  3. 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18:26:04 CST 2022, time=2022-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=999320, encodeId=1fb599932040, content=接受新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e5005540453, createdName=willing123, createdTime=Wed Jul 14 10:39:47 CST 2021, time=2021-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=960377, encodeId=884a9603e7c0, content=好好好, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e39e5226547, createdName=1478fcfem77暂无昵称, createdTime=Sun Apr 25 15:09:30 CST 2021, time=2021-04-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=958890, encodeId=8a08958890d3, content=很好,值得学习,怎么收藏呢, 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encodeId=e64a959142d4, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210121/3066131e88ca4c31a238db2bedac2f10/1d8e8a6a6c4c4256b2b4a24b6723d68a.jpg, createdBy=91092531490, createdName=滚滚兔🐰, createdTime=Wed Apr 21 18:28:37 CST 2021, time=2021-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1377643, encodeId=6d3a13e7643b1, content=<a href='/topic/show?id=5dfe4420fc' target=_blank style='color:#2F92EE;'>#CDS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4420, encryptionId=5dfe4420fc, topicName=CDS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ec25412, createdName=yangpeizhi, createdTime=Wed Apr 21 09:37:46 CST 2021, time=2021-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1549686, encodeId=903c1549686bd, content=<a href='/topic/show?id=f7879600061' target=_blank style='color:#2F92EE;'>#重磅#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, 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=Wed Apr 21 09:37:46 CST 2021, time=2021-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=958862, encodeId=b16f958862f0, content=收藏学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210125/9e5998de75824d5f8a8e76ad7ca79433/206fffa392c54ae5a60152c166e2f362.jpg, createdBy=ab0d5455599, createdName=二爽, createdTime=Tue Apr 20 20:33:27 CST 2021, time=2021-04-20, status=1, ipAttribution=)]
    2021-07-14 willing123

    接受新知识

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=2078350, encodeId=9eea20e835090, content=<a href='/topic/show?id=b6c09e42962' target=_blank style='color:#2F92EE;'>#防治指南#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97429, encryptionId=b6c09e42962, topicName=防治指南)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=322359, createdName=bioon3, createdTime=Thu Jul 15 00:37:46 CST 2021, time=2021-07-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1182589, encodeId=3fe611825895b, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211111/81c0b64745c644319545ec26d7ef0b34/9ddb2864d5df4dd9bf4305e380bffc96.jpg, createdBy=c7835705079, createdName=屋顶瞄爱赏月, createdTime=Sun Jan 09 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encodeId=e64a959142d4, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210121/3066131e88ca4c31a238db2bedac2f10/1d8e8a6a6c4c4256b2b4a24b6723d68a.jpg, createdBy=91092531490, createdName=滚滚兔🐰, createdTime=Wed Apr 21 18:28:37 CST 2021, time=2021-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1377643, encodeId=6d3a13e7643b1, content=<a href='/topic/show?id=5dfe4420fc' target=_blank style='color:#2F92EE;'>#CDS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4420, encryptionId=5dfe4420fc, topicName=CDS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ec25412, createdName=yangpeizhi, createdTime=Wed Apr 21 09:37:46 CST 2021, time=2021-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1549686, encodeId=903c1549686bd, content=<a href='/topic/show?id=f7879600061' target=_blank style='color:#2F92EE;'>#重磅#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, 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=Wed Apr 21 09:37:46 CST 2021, time=2021-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=958862, encodeId=b16f958862f0, content=收藏学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210125/9e5998de75824d5f8a8e76ad7ca79433/206fffa392c54ae5a60152c166e2f362.jpg, createdBy=ab0d5455599, createdName=二爽, createdTime=Tue Apr 20 20:33:27 CST 2021, time=2021-04-20, status=1, ipAttribution=)]
    2021-04-25 1478fcfem77暂无昵称

    好好好

    0

  5. 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encodeId=e64a959142d4, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210121/3066131e88ca4c31a238db2bedac2f10/1d8e8a6a6c4c4256b2b4a24b6723d68a.jpg, createdBy=91092531490, createdName=滚滚兔🐰, createdTime=Wed Apr 21 18:28:37 CST 2021, time=2021-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1377643, encodeId=6d3a13e7643b1, content=<a href='/topic/show?id=5dfe4420fc' target=_blank style='color:#2F92EE;'>#CDS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4420, encryptionId=5dfe4420fc, topicName=CDS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ec25412, createdName=yangpeizhi, createdTime=Wed Apr 21 09:37:46 CST 2021, time=2021-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1549686, encodeId=903c1549686bd, content=<a href='/topic/show?id=f7879600061' target=_blank style='color:#2F92EE;'>#重磅#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, 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=Wed Apr 21 09:37:46 CST 2021, time=2021-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=958862, encodeId=b16f958862f0, content=收藏学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210125/9e5998de75824d5f8a8e76ad7ca79433/206fffa392c54ae5a60152c166e2f362.jpg, createdBy=ab0d5455599, createdName=二爽, createdTime=Tue Apr 20 20:33:27 CST 2021, time=2021-04-20, status=1, ipAttribution=)]
    2021-04-20 柳城肾斗士

    很好,值得学习,怎么收藏呢

    0

  6. 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18:26:04 CST 2022, time=2022-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=999320, encodeId=1fb599932040, content=接受新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e5005540453, createdName=willing123, createdTime=Wed Jul 14 10:39:47 CST 2021, time=2021-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=960377, encodeId=884a9603e7c0, content=好好好, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e39e5226547, createdName=1478fcfem77暂无昵称, createdTime=Sun Apr 25 15:09:30 CST 2021, time=2021-04-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=958890, encodeId=8a08958890d3, content=很好,值得学习,怎么收藏呢, 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1549686, encodeId=903c1549686bd, content=<a href='/topic/show?id=f7879600061' target=_blank style='color:#2F92EE;'>#重磅#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, 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=Wed Apr 21 09:37:46 CST 2021, time=2021-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=958862, encodeId=b16f958862f0, content=收藏学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210125/9e5998de75824d5f8a8e76ad7ca79433/206fffa392c54ae5a60152c166e2f362.jpg, createdBy=ab0d5455599, createdName=二爽, createdTime=Tue Apr 20 20:33:27 CST 2021, time=2021-04-20, status=1, ipAttribution=)]
    2021-04-22 ms1000000765466241

    真棒

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=2078350, encodeId=9eea20e835090, content=<a href='/topic/show?id=b6c09e42962' target=_blank style='color:#2F92EE;'>#防治指南#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97429, encryptionId=b6c09e42962, topicName=防治指南)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=322359, createdName=bioon3, createdTime=Thu Jul 15 00:37:46 CST 2021, time=2021-07-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1182589, encodeId=3fe611825895b, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211111/81c0b64745c644319545ec26d7ef0b34/9ddb2864d5df4dd9bf4305e380bffc96.jpg, createdBy=c7835705079, createdName=屋顶瞄爱赏月, createdTime=Sun Jan 09 18:26:04 CST 2022, time=2022-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=999320, encodeId=1fb599932040, content=接受新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e5005540453, createdName=willing123, createdTime=Wed Jul 14 10:39:47 CST 2021, time=2021-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=960377, encodeId=884a9603e7c0, content=好好好, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e39e5226547, createdName=1478fcfem77暂无昵称, createdTime=Sun Apr 25 15:09:30 CST 2021, time=2021-04-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=958890, encodeId=8a08958890d3, content=很好,值得学习,怎么收藏呢, 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encodeId=e64a959142d4, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210121/3066131e88ca4c31a238db2bedac2f10/1d8e8a6a6c4c4256b2b4a24b6723d68a.jpg, createdBy=91092531490, createdName=滚滚兔🐰, createdTime=Wed Apr 21 18:28:37 CST 2021, time=2021-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1377643, encodeId=6d3a13e7643b1, content=<a href='/topic/show?id=5dfe4420fc' target=_blank style='color:#2F92EE;'>#CDS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4420, encryptionId=5dfe4420fc, topicName=CDS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ec25412, createdName=yangpeizhi, createdTime=Wed Apr 21 09:37:46 CST 2021, time=2021-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1549686, encodeId=903c1549686bd, content=<a href='/topic/show?id=f7879600061' target=_blank style='color:#2F92EE;'>#重磅#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, 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=Wed Apr 21 09:37:46 CST 2021, time=2021-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=958862, encodeId=b16f958862f0, content=收藏学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210125/9e5998de75824d5f8a8e76ad7ca79433/206fffa392c54ae5a60152c166e2f362.jpg, createdBy=ab0d5455599, createdName=二爽, createdTime=Tue Apr 20 20:33:27 CST 2021, time=2021-04-20, status=1, ipAttribution=)]
    2021-04-21 滚滚兔🐰

    学习了

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=2078350, encodeId=9eea20e835090, content=<a href='/topic/show?id=b6c09e42962' target=_blank style='color:#2F92EE;'>#防治指南#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97429, encryptionId=b6c09e42962, topicName=防治指南)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=322359, createdName=bioon3, createdTime=Thu Jul 15 00:37:46 CST 2021, time=2021-07-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1182589, encodeId=3fe611825895b, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211111/81c0b64745c644319545ec26d7ef0b34/9ddb2864d5df4dd9bf4305e380bffc96.jpg, createdBy=c7835705079, createdName=屋顶瞄爱赏月, createdTime=Sun Jan 09 18:26:04 CST 2022, time=2022-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=999320, encodeId=1fb599932040, content=接受新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e5005540453, createdName=willing123, createdTime=Wed Jul 14 10:39:47 CST 2021, time=2021-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=960377, encodeId=884a9603e7c0, content=好好好, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e39e5226547, createdName=1478fcfem77暂无昵称, createdTime=Sun Apr 25 15:09:30 CST 2021, time=2021-04-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=958890, encodeId=8a08958890d3, content=很好,值得学习,怎么收藏呢, 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encodeId=e64a959142d4, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210121/3066131e88ca4c31a238db2bedac2f10/1d8e8a6a6c4c4256b2b4a24b6723d68a.jpg, createdBy=91092531490, createdName=滚滚兔🐰, createdTime=Wed Apr 21 18:28:37 CST 2021, time=2021-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1377643, encodeId=6d3a13e7643b1, content=<a href='/topic/show?id=5dfe4420fc' target=_blank style='color:#2F92EE;'>#CDS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4420, encryptionId=5dfe4420fc, topicName=CDS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ec25412, createdName=yangpeizhi, createdTime=Wed Apr 21 09:37:46 CST 2021, time=2021-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1549686, encodeId=903c1549686bd, content=<a href='/topic/show?id=f7879600061' target=_blank style='color:#2F92EE;'>#重磅#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, 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=Wed Apr 21 09:37:46 CST 2021, time=2021-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=958862, encodeId=b16f958862f0, content=收藏学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210125/9e5998de75824d5f8a8e76ad7ca79433/206fffa392c54ae5a60152c166e2f362.jpg, createdBy=ab0d5455599, createdName=二爽, createdTime=Tue Apr 20 20:33:27 CST 2021, time=2021-04-20, status=1, ipAttribution=)]
    2021-04-21 yangpeizhi
  9. 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1549686, encodeId=903c1549686bd, content=<a href='/topic/show?id=f7879600061' target=_blank style='color:#2F92EE;'>#重磅#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, 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=Wed Apr 21 09:37:46 CST 2021, time=2021-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=958862, encodeId=b16f958862f0, content=收藏学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210125/9e5998de75824d5f8a8e76ad7ca79433/206fffa392c54ae5a60152c166e2f362.jpg, createdBy=ab0d5455599, createdName=二爽, createdTime=Tue Apr 20 20:33:27 CST 2021, time=2021-04-20, status=1, ipAttribution=)]
    2021-04-21 xxxx1054
  10. 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    2021-04-20 二爽

    收藏学习

    0