Hepatobiliary Surg Nutr:高HbA1c是肝切除术后并发症的危险因素,并对无肝炎感染的肝细胞癌产生影响

2021-11-10 从医路漫漫 MedSci原创

2型糖尿病(DM)由于胰岛素分泌受损和/或抵抗造成,导致高血糖的发生。患有肝病的患者通常同时存在胰岛素抵抗。

背景:2型糖尿病(DM)由于胰岛素分泌受损和/或抵抗造成,导致高血糖的发生。患有肝病的患者通常同时存在胰岛素抵抗。众所周知,糖尿病会导致心血管疾病、神经病变、视网膜病变和慢性肾功能衰竭等并发症。此外,糖尿病患者的数量每年都在显著增加。事国际糖尿病联合会报告称,2014年全球有3.87亿糖尿病患者,到2035年,这一数字可能会增加到5.92亿。糖尿病也是已知的恶性肿瘤的危险因素,如胰腺癌、肺癌、结肠癌和肝细胞癌(HCC)。然而,糖尿病或高血糖对切除肝细胞癌(HCC)预后的影响尚不清楚。

方法:2001年1月至2018年12月,排除乙型肝炎病毒(HBV)和丙型肝炎病毒(HCV)同时感染的15例,对756例接受肝切除术的肝癌患者的临床资料进行分析。根据入院时糖化血红蛋白水平,将这些患者分为糖化血红蛋白≥<7.0%组(H-A1c;n=100)和糖化血红蛋白<7.0%组(L-A1c;n=656)。日本糖尿病协会建议保持HbA1c<7.0%以预防并发症。

我们比较了H-A1c组和L-A1c组的生存、复发、临床病理特征、手术结果和发病率的预后。此外,我们评估了糖尿病治疗对无HBV和HCV的HCC患者(NBNC患者)预后的影响。HBV包括仅有HBV感染的患者,HCV包括仅有HCV感染的患者,NBNC包括既无HBV也无HCV感染的患者。

肝切除术的适应症和手术方式通常根据患者的肝功能储备,即15min吲哚菁绿保留试验(ICGR15)的结果来确定。解剖切除是指对ICGR15低于25%的患者,根据Couinaud的分类(节段切除术、切片切除术、半肝切除术或以上),对病变进行完全解剖切除。非解剖性部分但完全切除。所有患者的手术切除表面在组织学和肉眼观察上均无肝细胞癌。肝切除术后每隔3个月进行随访分析,包括体格检查、血清学检测[肝功能检测、血清甲胎蛋白(AFP)水平、维生素K缺失- ii (PIVKA-II)诱导的血清蛋白]、以及放射检查[超声超声(US)和对比增强计算机断层扫描(CT)或对比增强磁共振成像(MRI)]检查。根据增强CT和血清AFP和/或PIVKA-II水平升高的结果诊断复发。肝外转移(肺、淋巴结、肾上腺、脑和骨)通过胸部和腹部CT增强,头部增强MRI和骨平片进行诊断。中位随访时间为32个月(范围1.0-172个月)。

术后发病率采用Clavien-Dindo的有效分类系统进行评估。严重并发症分为III-V级,并定义为需要手术或放射治疗的发病率。

结果:在所有患者和乙型肝炎病毒(HBV)和丙型肝炎病毒(HCV)感染者中,H-A1c组和L-A1c组的总生存期(OS)和无复发生存期(RFS)无显著差异。相比之下,在无HBV和HCV感染的患者(NBNC患者)中,H-A1c组和L-A1c组的5年OS率分别为55%和71%(P=0.03)。在NBNC患者中,H-A1c组的中位RFS为13个月,L-A1c组为26个月(P=0.02)。此外,二甲双胍的使用对OS和RFS都是一个独立的有利因素。H-A1c组高胆红素血症、伤口感染和肺炎的发生率明显较高。

图1 总体生存曲线:(A)所有HCC患者;(B)以NBNC为基础的HCC患者。肝癌,肝细胞癌;NBNC NonBNonC。

图2 无复发生存曲线:(A)所有HCC患者;(B)以NBNC为基础的HCC患者。肝癌,肝细胞癌;NBNC NonBNonC。

表1 NBNC-HCC的临床病理特征

表2 NBNC-HCC的生存和复发的预后因素

图3 (A)糖尿病患者的总生存曲线和(B)糖尿病患者的无复发生存曲线。

表3 手术的结果

结论:HbA1c升高的肝癌患者在NBNC-HCC中生存和复发的预后可能都较差。高HbA1c也可能是肝切除术后发病率的危险因素。二甲双胍的使用可能是NBNC肝癌患者的一个很好的选择。

原文出处:

Shimada S,  Kamiyama T,  Orimo T,et al.High HbA1c is a risk factor for complications after hepatectomy and influences for hepatocellular carcinoma without HBV and HCV infection.Hepatobiliary Surg Nutr 2021 Aug;10(4)

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style='color:#2F92EE;'>#EPA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6851, encryptionId=221d685172, topicName=EPA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4a9b4077760, createdName=gwc384, createdTime=Thu Nov 11 12:33:02 CST 2021, time=2021-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1454791, encodeId=c62d1454e91a5, content=<a href='/topic/show?id=1a15340ed7' target=_blank style='color:#2F92EE;'>#Biliary#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3407, encryptionId=1a15340ed7, topicName=Biliary)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c02c5601798, createdName=echonoir, createdTime=Thu Nov 11 12:33:02 CST 2021, time=2021-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1069129, encodeId=b6a610691296a, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=76431956246, createdName=1e126935m22(暂无匿称), createdTime=Wed Nov 10 23:11:04 CST 2021, time=2021-11-10, status=1, ipAttribution=)]
    2022-09-10 Smile2680
  4. [GetPortalCommentsPageByObjectIdResponse(id=1926431, encodeId=fbcd1926431a0, content=<a href='/topic/show?id=a6ba8118009' target=_blank style='color:#2F92EE;'>#肝切除#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81180, encryptionId=a6ba8118009, topicName=肝切除)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=32d177, createdName=changfy, createdTime=Sun Jun 12 20:33:02 CST 2022, time=2022-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1979234, encodeId=d5b419e923408, content=<a href='/topic/show?id=3b90e79787f' target=_blank style='color:#2F92EE;'>#细胞癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77978, encryptionId=3b90e79787f, topicName=细胞癌)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e457184, 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style='color:#2F92EE;'>#EPA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6851, encryptionId=221d685172, topicName=EPA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4a9b4077760, createdName=gwc384, createdTime=Thu Nov 11 12:33:02 CST 2021, time=2021-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1454791, encodeId=c62d1454e91a5, content=<a href='/topic/show?id=1a15340ed7' target=_blank style='color:#2F92EE;'>#Biliary#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3407, encryptionId=1a15340ed7, topicName=Biliary)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c02c5601798, createdName=echonoir, createdTime=Thu Nov 11 12:33:02 CST 2021, time=2021-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1069129, encodeId=b6a610691296a, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=76431956246, createdName=1e126935m22(暂无匿称), createdTime=Wed Nov 10 23:11:04 CST 2021, time=2021-11-10, status=1, ipAttribution=)]
    2022-03-09 丁鹏鹏
  5. 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style='color:#2F92EE;'>#EPA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6851, encryptionId=221d685172, topicName=EPA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4a9b4077760, createdName=gwc384, createdTime=Thu Nov 11 12:33:02 CST 2021, time=2021-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1454791, encodeId=c62d1454e91a5, content=<a href='/topic/show?id=1a15340ed7' target=_blank style='color:#2F92EE;'>#Biliary#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3407, encryptionId=1a15340ed7, topicName=Biliary)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c02c5601798, createdName=echonoir, createdTime=Thu Nov 11 12:33:02 CST 2021, time=2021-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1069129, encodeId=b6a610691296a, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=76431956246, createdName=1e126935m22(暂无匿称), createdTime=Wed Nov 10 23:11:04 CST 2021, time=2021-11-10, status=1, ipAttribution=)]
    2021-12-09 xjy02
  6. [GetPortalCommentsPageByObjectIdResponse(id=1926431, encodeId=fbcd1926431a0, content=<a href='/topic/show?id=a6ba8118009' target=_blank style='color:#2F92EE;'>#肝切除#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81180, encryptionId=a6ba8118009, topicName=肝切除)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=32d177, createdName=changfy, createdTime=Sun Jun 12 20:33:02 CST 2022, time=2022-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1979234, encodeId=d5b419e923408, content=<a href='/topic/show?id=3b90e79787f' target=_blank style='color:#2F92EE;'>#细胞癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77978, encryptionId=3b90e79787f, topicName=细胞癌)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e457184, 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style='color:#2F92EE;'>#EPA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6851, encryptionId=221d685172, topicName=EPA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4a9b4077760, createdName=gwc384, createdTime=Thu Nov 11 12:33:02 CST 2021, time=2021-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1454791, encodeId=c62d1454e91a5, content=<a href='/topic/show?id=1a15340ed7' target=_blank style='color:#2F92EE;'>#Biliary#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3407, encryptionId=1a15340ed7, topicName=Biliary)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c02c5601798, createdName=echonoir, createdTime=Thu Nov 11 12:33:02 CST 2021, time=2021-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1069129, encodeId=b6a610691296a, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=76431956246, createdName=1e126935m22(暂无匿称), createdTime=Wed Nov 10 23:11:04 CST 2021, time=2021-11-10, status=1, ipAttribution=)]
  7. [GetPortalCommentsPageByObjectIdResponse(id=1926431, encodeId=fbcd1926431a0, content=<a href='/topic/show?id=a6ba8118009' target=_blank style='color:#2F92EE;'>#肝切除#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81180, encryptionId=a6ba8118009, topicName=肝切除)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=32d177, createdName=changfy, createdTime=Sun Jun 12 20:33:02 CST 2022, time=2022-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1979234, encodeId=d5b419e923408, content=<a href='/topic/show?id=3b90e79787f' target=_blank style='color:#2F92EE;'>#细胞癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77978, encryptionId=3b90e79787f, topicName=细胞癌)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e457184, 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topicName=并发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a27e37327108, createdName=丁鹏鹏, createdTime=Wed Mar 09 11:33:02 CST 2022, time=2022-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1863624, encodeId=21251863624c7, content=<a href='/topic/show?id=c0b68135561' target=_blank style='color:#2F92EE;'>#肝细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81355, encryptionId=c0b68135561, topicName=肝细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d59291, createdName=xjy02, createdTime=Thu Dec 09 00:33:02 CST 2021, time=2021-12-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1877506, encodeId=930818e750665, content=<a href='/topic/show?id=67c5319121e' target=_blank style='color:#2F92EE;'>#切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31912, encryptionId=67c5319121e, topicName=切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9d8a96, createdName=doctorzheng, createdTime=Thu May 05 18:33:02 CST 2022, time=2022-05-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1417905, encodeId=1fd9141e90539, content=<a href='/topic/show?id=bcb081181dc' target=_blank style='color:#2F92EE;'>#肝切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81181, encryptionId=bcb081181dc, topicName=肝切除术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1bcb3304824, createdName=zexyw02, createdTime=Thu Nov 11 12:33:02 CST 2021, time=2021-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1427572, encodeId=701f142e57274, content=<a href='/topic/show?id=221d685172' target=_blank style='color:#2F92EE;'>#EPA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6851, encryptionId=221d685172, topicName=EPA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4a9b4077760, createdName=gwc384, createdTime=Thu Nov 11 12:33:02 CST 2021, time=2021-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1454791, encodeId=c62d1454e91a5, content=<a href='/topic/show?id=1a15340ed7' target=_blank style='color:#2F92EE;'>#Biliary#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3407, encryptionId=1a15340ed7, topicName=Biliary)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c02c5601798, createdName=echonoir, createdTime=Thu Nov 11 12:33:02 CST 2021, time=2021-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1069129, encodeId=b6a610691296a, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=76431956246, createdName=1e126935m22(暂无匿称), createdTime=Wed Nov 10 23:11:04 CST 2021, time=2021-11-10, status=1, ipAttribution=)]
  8. [GetPortalCommentsPageByObjectIdResponse(id=1926431, encodeId=fbcd1926431a0, content=<a href='/topic/show?id=a6ba8118009' target=_blank style='color:#2F92EE;'>#肝切除#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81180, encryptionId=a6ba8118009, topicName=肝切除)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=32d177, createdName=changfy, createdTime=Sun Jun 12 20:33:02 CST 2022, time=2022-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1979234, encodeId=d5b419e923408, content=<a href='/topic/show?id=3b90e79787f' target=_blank style='color:#2F92EE;'>#细胞癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77978, encryptionId=3b90e79787f, topicName=细胞癌)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e457184, createdName=qingting, createdTime=Sun Sep 25 12:33:02 CST 2022, time=2022-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2015977, encodeId=17c220159e782, content=<a href='/topic/show?id=33108494c1' target=_blank style='color:#2F92EE;'>#HbA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8494, encryptionId=33108494c1, topicName=HbA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c48a270, createdName=Smile2680, createdTime=Sat Sep 10 04:33:02 CST 2022, time=2022-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1758387, encodeId=aa5a1e5838791, content=<a href='/topic/show?id=84ba49031f9' target=_blank style='color:#2F92EE;'>#并发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49031, encryptionId=84ba49031f9, topicName=并发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a27e37327108, createdName=丁鹏鹏, createdTime=Wed Mar 09 11:33:02 CST 2022, time=2022-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1863624, encodeId=21251863624c7, content=<a href='/topic/show?id=c0b68135561' target=_blank style='color:#2F92EE;'>#肝细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81355, encryptionId=c0b68135561, topicName=肝细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d59291, createdName=xjy02, createdTime=Thu Dec 09 00:33:02 CST 2021, time=2021-12-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1877506, encodeId=930818e750665, content=<a href='/topic/show?id=67c5319121e' target=_blank style='color:#2F92EE;'>#切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31912, encryptionId=67c5319121e, topicName=切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9d8a96, createdName=doctorzheng, createdTime=Thu May 05 18:33:02 CST 2022, time=2022-05-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1417905, encodeId=1fd9141e90539, content=<a href='/topic/show?id=bcb081181dc' target=_blank style='color:#2F92EE;'>#肝切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81181, encryptionId=bcb081181dc, topicName=肝切除术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1bcb3304824, createdName=zexyw02, createdTime=Thu Nov 11 12:33:02 CST 2021, time=2021-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1427572, encodeId=701f142e57274, content=<a href='/topic/show?id=221d685172' target=_blank style='color:#2F92EE;'>#EPA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6851, encryptionId=221d685172, topicName=EPA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4a9b4077760, createdName=gwc384, createdTime=Thu Nov 11 12:33:02 CST 2021, time=2021-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1454791, encodeId=c62d1454e91a5, content=<a href='/topic/show?id=1a15340ed7' target=_blank style='color:#2F92EE;'>#Biliary#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3407, encryptionId=1a15340ed7, topicName=Biliary)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c02c5601798, createdName=echonoir, createdTime=Thu Nov 11 12:33:02 CST 2021, time=2021-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1069129, encodeId=b6a610691296a, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=76431956246, createdName=1e126935m22(暂无匿称), createdTime=Wed Nov 10 23:11:04 CST 2021, time=2021-11-10, status=1, ipAttribution=)]
    2021-11-11 gwc384
  9. [GetPortalCommentsPageByObjectIdResponse(id=1926431, encodeId=fbcd1926431a0, content=<a href='/topic/show?id=a6ba8118009' target=_blank style='color:#2F92EE;'>#肝切除#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81180, encryptionId=a6ba8118009, topicName=肝切除)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=32d177, createdName=changfy, createdTime=Sun Jun 12 20:33:02 CST 2022, time=2022-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1979234, encodeId=d5b419e923408, content=<a href='/topic/show?id=3b90e79787f' target=_blank style='color:#2F92EE;'>#细胞癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77978, encryptionId=3b90e79787f, topicName=细胞癌)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e457184, 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topicName=并发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a27e37327108, createdName=丁鹏鹏, createdTime=Wed Mar 09 11:33:02 CST 2022, time=2022-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1863624, encodeId=21251863624c7, content=<a href='/topic/show?id=c0b68135561' target=_blank style='color:#2F92EE;'>#肝细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81355, encryptionId=c0b68135561, topicName=肝细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d59291, createdName=xjy02, createdTime=Thu Dec 09 00:33:02 CST 2021, time=2021-12-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1877506, encodeId=930818e750665, content=<a href='/topic/show?id=67c5319121e' target=_blank style='color:#2F92EE;'>#切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31912, encryptionId=67c5319121e, topicName=切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9d8a96, createdName=doctorzheng, createdTime=Thu May 05 18:33:02 CST 2022, time=2022-05-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1417905, encodeId=1fd9141e90539, content=<a href='/topic/show?id=bcb081181dc' target=_blank style='color:#2F92EE;'>#肝切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81181, encryptionId=bcb081181dc, topicName=肝切除术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1bcb3304824, createdName=zexyw02, createdTime=Thu Nov 11 12:33:02 CST 2021, time=2021-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1427572, encodeId=701f142e57274, content=<a href='/topic/show?id=221d685172' target=_blank style='color:#2F92EE;'>#EPA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6851, encryptionId=221d685172, topicName=EPA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4a9b4077760, createdName=gwc384, createdTime=Thu Nov 11 12:33:02 CST 2021, time=2021-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1454791, encodeId=c62d1454e91a5, content=<a href='/topic/show?id=1a15340ed7' target=_blank style='color:#2F92EE;'>#Biliary#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3407, encryptionId=1a15340ed7, topicName=Biliary)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c02c5601798, createdName=echonoir, createdTime=Thu Nov 11 12:33:02 CST 2021, time=2021-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1069129, encodeId=b6a610691296a, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=76431956246, createdName=1e126935m22(暂无匿称), createdTime=Wed Nov 10 23:11:04 CST 2021, time=2021-11-10, status=1, ipAttribution=)]
    2021-11-11 echonoir
  10. [GetPortalCommentsPageByObjectIdResponse(id=1926431, encodeId=fbcd1926431a0, content=<a href='/topic/show?id=a6ba8118009' target=_blank style='color:#2F92EE;'>#肝切除#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81180, encryptionId=a6ba8118009, topicName=肝切除)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=32d177, createdName=changfy, createdTime=Sun Jun 12 20:33:02 CST 2022, time=2022-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1979234, encodeId=d5b419e923408, content=<a href='/topic/show?id=3b90e79787f' target=_blank style='color:#2F92EE;'>#细胞癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77978, encryptionId=3b90e79787f, topicName=细胞癌)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e457184, 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style='color:#2F92EE;'>#EPA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6851, encryptionId=221d685172, topicName=EPA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4a9b4077760, createdName=gwc384, createdTime=Thu Nov 11 12:33:02 CST 2021, time=2021-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1454791, encodeId=c62d1454e91a5, content=<a href='/topic/show?id=1a15340ed7' target=_blank style='color:#2F92EE;'>#Biliary#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3407, encryptionId=1a15340ed7, topicName=Biliary)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c02c5601798, createdName=echonoir, createdTime=Thu Nov 11 12:33:02 CST 2021, time=2021-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1069129, encodeId=b6a610691296a, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=76431956246, createdName=1e126935m22(暂无匿称), createdTime=Wed Nov 10 23:11:04 CST 2021, time=2021-11-10, status=1, ipAttribution=)]
    2021-11-10 1e126935m22(暂无匿称)

    学习了

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