BMJ:重磅!冠脉重建后DAPT治疗的核心地位被动摇,P2Y12抑制剂单药治疗或收益更大

2021-06-18 MedSci原创 MedSci原创

评估P2Y12抑制剂单药治疗与双抗血小板治疗(DAPT)的风险和收益,以及这些关联是否因患者的特点而改变。

血小板P2Y12受体信号通路的抑制在心脑血管血栓性并发症的二级预防中起着核心作用。口服P2Y12抑制剂主要是冠脉重建后与阿司匹林联合使用的研究。在此背景下,有证据表明与单独服用阿司匹林相比,阿司匹林+P2Y12抑制剂组成的双重抗血小板治疗(DAPT)减轻了缺血事件的发生率,但也增加了大出血的风险。

一些研究评估了口服P2Y12抑制剂单一疗法作为传统DAPT的替代方案。然而,没有人能够评估停用阿司匹林并继续口服P2Y12抑制剂是否能维持后者与阿司匹林联合的治疗效果。先前对口服P2Y12抑制剂单药治疗研究的汇总数据荟萃分析包括了在DAPT初期发生的事件,在大多数研究中,实验方案和对照方案都是相同的,因此没有最终确定停用阿司匹林的风险和好处,也没有探索跨亚组治疗效果的一致性。

因此,人们仍然担心短时间服用DAPT后停用阿司匹林可能与更高的缺血性事件风险相关,尤其是在具有高危特征的患者中。2020年欧洲心脏病学会(European Society of Cardiology)关于无ST段抬高患者急性冠状动脉综合征管理的指南指出,3至6个月的DAPT疗程后停用阿司匹林,继续使用P2Y12抑制剂单药治疗,应根据缺血风险和出血风险之间的平衡来考虑。美国心脏协会/美国心脏病学会指南还没有对这种治疗方案发布正式建议。

基于这些背景,有研究小组在所有接受冠状动脉重建的患者中比较了P2Y12抑制剂单药治疗与DAPT的随机试验进行了系统回顾和个人参与者数据荟萃分析,重点关注阿司匹林去除后治疗效果的保留,并在预先定义的亚组中调查其一致性。该研究结果近日发表在BMJ上。

该研究为随机对照试验的个体患者水平荟萃分析。主要结局是所有原因的死亡、心肌梗死和中风的综合,检测非劣效性,危险比的边际为1.15。

荟萃分析包括6个试验的数据,24096名患者。主要转归发生在283例(2.95%)单独使用P2Y12抑制剂的患者和315例(3.27%)使用DAPT的患者中,以及303例(2.94%)单独使用P2Y12抑制剂的患者和338例(3.36%)使用DAPT的意向治疗人群中。

除性别外,所有亚组的治疗效果一致,表明P2Y12抑制剂单一治疗可降低女性主要缺血终点的风险(危险比为0.64,0.46至0.89),但男性没有。P2Y12抑制剂单药治疗的出血风险低于DAPT,这在亚组间是一致的,P2Y12抑制剂的类型除外,这表明当新的P2Y12抑制剂而不是氯吡格雷作为DAPT方案的一部分时获益更大。

个体试验和汇总人群的危险比,以及所有原因死亡、心肌梗死或卒中主要终点的Kaplan-Meier估计。

这些个体参与者数据提供了强有力的证据,表明P2Y12抑制剂单药治疗不低于DAPT。与DAPT相比,P2Y12抑制剂单药治疗与更低的大出血风险和净不良临床事件相关。所有敏感性分析均证实了主要研究结果。分析表明,女性患者可能从P2Y12抑制剂单药治疗中获益,因为主要不良心血管事件的风险较低。P2Y12抑制剂单药治疗与较低的出血率一致,尽管在实验组和对照组中,这种治疗效果的大小因P2Y12抑制剂的效力而不同,这在实践中具有重要意义。

与DAPT相比,P2Y12抑制剂单一治疗与死亡、心肌梗死或中风的风险相似,但大出血的风险较低。这些关联可能分别受性别和P2Y12抑制剂类型的影响。与冠状动脉旁路移植术后DAPT相比,P2Y12抑制剂单药治疗的数据仅限于单一试验,需要进一步研究。研究者称,基于现有的全部证据,支持抗血栓治疗的范式转变,并有理由质疑经皮冠状动脉介入术后1-3个月后DAPT的中心作用。

参考文献:P2Y12 inhibitor monotherapy or dual antiplatelet therapy after coronary revascularisation: individual patient level meta-analysis of randomised controlled trials BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1332 (Published 16 June 2021)Cite this as: BMJ 2021;373:n1332

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    2022-02-09 liuquan
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    2022-01-28 gaoxiaoe
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    2022-02-23 jklm09
  4. [GetPortalCommentsPageByObjectIdResponse(id=1995633, encodeId=8759199563309, content=<a href='/topic/show?id=992411149e' target=_blank style='color:#2F92EE;'>#2抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1114, encryptionId=992411149e, topicName=2抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28b7142, createdName=liuquan, createdTime=Wed Feb 09 06:38:41 CST 2022, time=2022-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1849275, encodeId=5b9618492e5af, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Fri Jan 28 16:38:41 CST 2022, time=2022-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1852684, encodeId=a3fb18526844e, content=<a href='/topic/show?id=f0a254918f0' target=_blank style='color:#2F92EE;'>#抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Wed Feb 23 08:38:41 CST 2022, time=2022-02-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1687759, encodeId=d81b168e759e5, content=<a href='/topic/show?id=be223633375' target=_blank style='color:#2F92EE;'>#单药治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36333, encryptionId=be223633375, topicName=单药治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2bef28414326, createdName=12498717m75(暂无昵称), createdTime=Thu Sep 16 03:38:41 CST 2021, time=2021-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1940226, encodeId=d19019402263a, content=<a href='/topic/show?id=18f81361276' target=_blank style='color:#2F92EE;'>#P2Y12#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13612, encryptionId=18f81361276, topicName=P2Y12)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=yeye5224612, createdTime=Fri Jul 16 22:38:41 CST 2021, time=2021-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=975407, encodeId=371a9e5407aa, content=会改写指南吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4bb81518090, createdName=dahonghuayang, createdTime=Mon Jun 21 11:50:25 CST 2021, time=2021-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1374357, encodeId=382513e435704, content=<a href='/topic/show?id=6d5d56912e' target=_blank style='color:#2F92EE;'>#DAPT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5691, encryptionId=6d5d56912e, topicName=DAPT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6a8d381, createdName=mnda, createdTime=Sun Jun 20 11:38:41 CST 2021, time=2021-06-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1442736, encodeId=22de1442e3662, content=<a href='/topic/show?id=687313616b4' target=_blank style='color:#2F92EE;'>#P2Y12抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13616, encryptionId=687313616b4, topicName=P2Y12抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ff014972968, createdName=luckyshitiancai_42705685, createdTime=Sun Jun 20 11:38:41 CST 2021, time=2021-06-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1549701, encodeId=12431549e0177, content=<a href='/topic/show?id=f7879600061' target=_blank style='color:#2F92EE;'>#重磅#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, 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=Sun Jun 20 11:38:41 CST 2021, time=2021-06-20, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1995633, encodeId=8759199563309, content=<a href='/topic/show?id=992411149e' target=_blank style='color:#2F92EE;'>#2抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1114, encryptionId=992411149e, topicName=2抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28b7142, createdName=liuquan, createdTime=Wed Feb 09 06:38:41 CST 2022, time=2022-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1849275, encodeId=5b9618492e5af, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Fri Jan 28 16:38:41 CST 2022, time=2022-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1852684, encodeId=a3fb18526844e, content=<a href='/topic/show?id=f0a254918f0' target=_blank style='color:#2F92EE;'>#抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Wed Feb 23 08:38:41 CST 2022, time=2022-02-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1687759, encodeId=d81b168e759e5, content=<a href='/topic/show?id=be223633375' target=_blank style='color:#2F92EE;'>#单药治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36333, encryptionId=be223633375, topicName=单药治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2bef28414326, createdName=12498717m75(暂无昵称), createdTime=Thu Sep 16 03:38:41 CST 2021, time=2021-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1940226, encodeId=d19019402263a, content=<a href='/topic/show?id=18f81361276' target=_blank style='color:#2F92EE;'>#P2Y12#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13612, encryptionId=18f81361276, topicName=P2Y12)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=yeye5224612, createdTime=Fri Jul 16 22:38:41 CST 2021, time=2021-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=975407, encodeId=371a9e5407aa, content=会改写指南吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4bb81518090, createdName=dahonghuayang, createdTime=Mon Jun 21 11:50:25 CST 2021, time=2021-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1374357, encodeId=382513e435704, content=<a href='/topic/show?id=6d5d56912e' target=_blank style='color:#2F92EE;'>#DAPT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5691, encryptionId=6d5d56912e, topicName=DAPT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6a8d381, createdName=mnda, createdTime=Sun Jun 20 11:38:41 CST 2021, time=2021-06-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1442736, encodeId=22de1442e3662, content=<a href='/topic/show?id=687313616b4' target=_blank style='color:#2F92EE;'>#P2Y12抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13616, encryptionId=687313616b4, topicName=P2Y12抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ff014972968, createdName=luckyshitiancai_42705685, createdTime=Sun Jun 20 11:38:41 CST 2021, time=2021-06-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1549701, encodeId=12431549e0177, content=<a href='/topic/show?id=f7879600061' target=_blank style='color:#2F92EE;'>#重磅#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, 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=Sun Jun 20 11:38:41 CST 2021, time=2021-06-20, status=1, ipAttribution=)]
    2021-07-16 yeye5224612
  6. [GetPortalCommentsPageByObjectIdResponse(id=1995633, encodeId=8759199563309, content=<a href='/topic/show?id=992411149e' target=_blank style='color:#2F92EE;'>#2抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1114, encryptionId=992411149e, topicName=2抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28b7142, createdName=liuquan, createdTime=Wed Feb 09 06:38:41 CST 2022, time=2022-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1849275, encodeId=5b9618492e5af, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Fri Jan 28 16:38:41 CST 2022, time=2022-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1852684, encodeId=a3fb18526844e, content=<a href='/topic/show?id=f0a254918f0' target=_blank style='color:#2F92EE;'>#抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Wed Feb 23 08:38:41 CST 2022, time=2022-02-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1687759, encodeId=d81b168e759e5, content=<a href='/topic/show?id=be223633375' target=_blank style='color:#2F92EE;'>#单药治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36333, encryptionId=be223633375, topicName=单药治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2bef28414326, createdName=12498717m75(暂无昵称), createdTime=Thu Sep 16 03:38:41 CST 2021, time=2021-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1940226, encodeId=d19019402263a, content=<a href='/topic/show?id=18f81361276' target=_blank style='color:#2F92EE;'>#P2Y12#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13612, encryptionId=18f81361276, topicName=P2Y12)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=yeye5224612, createdTime=Fri Jul 16 22:38:41 CST 2021, time=2021-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=975407, encodeId=371a9e5407aa, content=会改写指南吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4bb81518090, createdName=dahonghuayang, createdTime=Mon Jun 21 11:50:25 CST 2021, time=2021-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1374357, encodeId=382513e435704, content=<a href='/topic/show?id=6d5d56912e' target=_blank style='color:#2F92EE;'>#DAPT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5691, encryptionId=6d5d56912e, topicName=DAPT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6a8d381, createdName=mnda, createdTime=Sun Jun 20 11:38:41 CST 2021, time=2021-06-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1442736, encodeId=22de1442e3662, content=<a href='/topic/show?id=687313616b4' target=_blank style='color:#2F92EE;'>#P2Y12抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13616, encryptionId=687313616b4, topicName=P2Y12抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ff014972968, createdName=luckyshitiancai_42705685, createdTime=Sun Jun 20 11:38:41 CST 2021, time=2021-06-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1549701, encodeId=12431549e0177, content=<a href='/topic/show?id=f7879600061' target=_blank style='color:#2F92EE;'>#重磅#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, 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=Sun Jun 20 11:38:41 CST 2021, time=2021-06-20, status=1, ipAttribution=)]
    2021-06-21 dahonghuayang

    会改写指南吗

    0

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    2021-06-20 mnda
  8. [GetPortalCommentsPageByObjectIdResponse(id=1995633, encodeId=8759199563309, content=<a href='/topic/show?id=992411149e' target=_blank style='color:#2F92EE;'>#2抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1114, encryptionId=992411149e, topicName=2抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28b7142, createdName=liuquan, createdTime=Wed Feb 09 06:38:41 CST 2022, time=2022-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1849275, encodeId=5b9618492e5af, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Fri Jan 28 16:38:41 CST 2022, time=2022-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1852684, encodeId=a3fb18526844e, content=<a href='/topic/show?id=f0a254918f0' target=_blank style='color:#2F92EE;'>#抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Wed Feb 23 08:38:41 CST 2022, time=2022-02-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1687759, encodeId=d81b168e759e5, content=<a href='/topic/show?id=be223633375' target=_blank style='color:#2F92EE;'>#单药治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36333, encryptionId=be223633375, topicName=单药治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2bef28414326, createdName=12498717m75(暂无昵称), createdTime=Thu Sep 16 03:38:41 CST 2021, time=2021-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1940226, encodeId=d19019402263a, content=<a href='/topic/show?id=18f81361276' target=_blank style='color:#2F92EE;'>#P2Y12#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13612, encryptionId=18f81361276, topicName=P2Y12)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=yeye5224612, createdTime=Fri Jul 16 22:38:41 CST 2021, time=2021-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=975407, encodeId=371a9e5407aa, content=会改写指南吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4bb81518090, createdName=dahonghuayang, createdTime=Mon Jun 21 11:50:25 CST 2021, time=2021-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1374357, encodeId=382513e435704, content=<a href='/topic/show?id=6d5d56912e' target=_blank style='color:#2F92EE;'>#DAPT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5691, encryptionId=6d5d56912e, topicName=DAPT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6a8d381, createdName=mnda, createdTime=Sun Jun 20 11:38:41 CST 2021, time=2021-06-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1442736, encodeId=22de1442e3662, content=<a href='/topic/show?id=687313616b4' target=_blank style='color:#2F92EE;'>#P2Y12抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13616, encryptionId=687313616b4, topicName=P2Y12抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ff014972968, createdName=luckyshitiancai_42705685, createdTime=Sun Jun 20 11:38:41 CST 2021, time=2021-06-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1549701, encodeId=12431549e0177, content=<a href='/topic/show?id=f7879600061' target=_blank style='color:#2F92EE;'>#重磅#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, 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=Sun Jun 20 11:38:41 CST 2021, time=2021-06-20, status=1, ipAttribution=)]
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    2021-06-20 xxxx1054

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