骨孤立性浆细胞瘤误诊误治为脊柱结核1例

2018-11-25 卢斌 刘扬 刘丰平 广东医学

患者,女,38岁,因下腰背部及右下肢疼痛不适15d,加重1d,于2016年12月30日入院。患者于15d前无明显诱因出现腰背部及右下肢疼痛,起病后行腰椎CT检查提示:腰椎间盘膨出,给予对症处理后症状缓解不明显。1d前患者出现腰背部及右下肢疼痛加重,行走不能,伴发热,盗汗,遂行腰椎MRI检查提示:L3-4段椎管内硬膜外感染,脓肿形成,累及骨质及周围组织,结核感染可能性大,以“脊柱结核?”收住我科。

临床资料

患者,女,38岁,因下腰背部及右下肢疼痛不适15d,加重1d,于2016年12月30日入院。患者于15d前无明显诱因出现腰背部及右下肢疼痛,起病后行腰椎CT检查提示:腰椎间盘膨出,给予对症处理后症状缓解不明显。1d前患者出现腰背部及右下肢疼痛加重,行走不能,伴发热,盗汗,遂行腰椎MRI检查提示:L3-4段椎管内硬膜外感染,脓肿形成,累及骨质及周围组织,结核感染可能性大,以“脊柱结核?”收住我科。

专科查体:下腰背部棘突间有压痛及叩击痛,右大腿后、小腿前外侧有根性牵涉痛,右侧直腿抬高试验及加强试验(+),右侧足趾背伸肌力较左侧稍弱。入院后完善相关检查,查血:WBC、CRP、ESR轻度升高,结核感染T细胞检测(T-SPOT)阴性,结核蛋白芯片(-),双肺CT未见明显异常,腰椎平扫MRI如图1所示,余检查无特殊,考虑为脊柱结核伴椎旁脓肿,细菌感染不排除。给予抗结核药物四联2周(异烟肼300mg1次/d;利福平600mg1次/d;吡嗪酰胺1.5g1次/d;乙胺丁醇750mg1次/d)。于2016年1月14日复查腰椎MRI提示:脓肿较前无明显缩小,复查血象CRP、ESR较前无明显降低。于2017年1月16日在全麻下行后入路腰椎病灶清除+减压植骨融合内固定术,将取出的标本送病检,术后给予抗感染、营养神经、脱水等对症支持治疗,术后病检(图2)结果:免疫组化染色CD3(-);CD20(-);CD38(+);CD138(+);MUM-1(-);kappa(散在+);Lambda(散在+,Lambda>Kappa);Ki-67(L1约30%);CD79a(-);CD56(-),考虑骨孤立性浆细胞瘤(SPB)。请血液内科会诊后,转入血液内科行局部放疗+化疗(具体不详),出院后失访。


讨论

SPB是一种以浆细胞异常增殖的恶性肿瘤,它主要发生在全身红骨髓丰富的骨组织中,尤其好发于脊柱,其主要临床表现为病变部位的局部疼痛,若病灶侵犯脊髓或神经根,可出现与之相应的神经压迫症状。该疾患的诊断标准:(1)组织病理学证实为单一部位的单克隆细胞增殖;(2)其病变部位的影像学检查证实为局部的骨形态改变,常表现为原发病灶的局部侵犯征象;(3)骨髓细胞学检查通常未见明显异常,其浆细胞比率小于5%;(4)经相关检查已排除多发性骨髓瘤;(5)血清和尿单克隆免疫球蛋白含量较低。

本病被误诊为脊柱结核,分析其原因有:(1)患者伴有低热、盗汗等症状,血象、ESR及CRP呈轻度升高,腰椎MRI提示:椎管内硬膜外感染,结核可能性大;临床医师仅循证简单的问诊及影像科报告而作出错误的诊断;(2)对SPB的认识不足,因本病发病率极低,故临床医师对其缺乏认识,从而导致误诊误治;(3)因本病缺乏特异性,常表现为溶骨性破坏,病灶区常被软组织填充,甚至突破骨皮质形成软组织肿块,软组织信号通常较均匀,该患者腰椎MRI表现与上述影像学表现类似,但临床医师未能考虑到本病而误诊;(4)诊断思维局限,临床医师接诊患者时,仅考虑常见病及多发病,通过大致的询问病史、体格检查及辅助检查,就草率作出临床诊断,遗漏了患者的一些信息,如:患者无肺外结核病灶,腰椎MRI提示病灶未侵犯邻近椎间盘,腰椎CT未见死骨形成,椎旁未见脓肿。患者诊断性抗结核治疗+抗感染2周后,患者症状缓解不明显,复查腰椎MRI未见脓肿缩小,而这些表现均与脊柱结核不相符。

当临床医师接诊到发热、血象轻度升高、脊柱MRI提示椎管内软组织肿胀影,怀疑脊柱结核诊断时;尤其是当诊断与诊治过程出现矛盾时,我们应该要想到诊断是否正确,诊断是否有据可循。对临床高度怀疑SPB时,应行病变部位的MRI扫描及增强,必要时行病变部位组织病理学检查及免疫组化检查,亦有助于本病与脊柱结核等相互鉴别。

原始出处:

卢斌, 刘扬, 刘丰平, et al. 骨孤立性浆细胞瘤误诊误治为脊柱结核1例[J]. 广东医学, 2018(5).

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 (9)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1220638, encodeId=ba261220638dd, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2e845489837, createdName=金朝岁月, createdTime=Wed May 18 11:57:33 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1991946, encodeId=2e0f1991946d7, content=<a href='/topic/show?id=5a916544314' target=_blank style='color:#2F92EE;'>#浆细胞瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65443, encryptionId=5a916544314, topicName=浆细胞瘤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfab443, createdName=saikp, createdTime=Wed Jul 17 15:55:00 CST 2019, time=2019-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1821548, encodeId=4412182154877, content=<a href='/topic/show?id=35f5101638fb' target=_blank style='color:#2F92EE;'>#骨孤立性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101638, encryptionId=35f5101638fb, topicName=骨孤立性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1dfd2500156, createdName=12498c24m69暂无昵称, createdTime=Sat Jul 27 19:55:00 CST 2019, time=2019-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1254243, encodeId=974f12542434c, content=<a href='/topic/show?id=f30ae86297d' target=_blank style='color:#2F92EE;'>#结核#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78629, encryptionId=f30ae86297d, topicName=结核)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=huhuaidong387, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1466616, encodeId=b3e1146661698, content=<a href='/topic/show?id=8d3e65434d4' target=_blank style='color:#2F92EE;'>#浆细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65434, encryptionId=8d3e65434d4, topicName=浆细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=181c6846356, createdName=huangshifeng, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1475943, encodeId=919f14e5943a4, content=<a href='/topic/show?id=2bcee797732' target=_blank style='color:#2F92EE;'>#细胞瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77977, encryptionId=2bcee797732, topicName=细胞瘤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智智灵药, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1525631, encodeId=b440152563121, content=<a href='/topic/show?id=2ef14545092' target=_blank style='color:#2F92EE;'>#孤立性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45450, encryptionId=2ef14545092, topicName=孤立性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cdb511649913, createdName=jxrzshh, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1589492, encodeId=ea621589492d1, content=<a href='/topic/show?id=ec4584551b2' target=_blank style='color:#2F92EE;'>#脊柱结核#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84551, encryptionId=ec4584551b2, topicName=脊柱结核)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a42d17732962, createdName=3631179, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=353638, encodeId=8ae3353638d8, content=好文,值得点赞!认真学习了,把经验应用于实践,为患者解除病痛。, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Sun Nov 25 15:03:31 CST 2018, time=2018-11-25, status=1, ipAttribution=)]
    2022-05-18 金朝岁月

    学习了

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1220638, encodeId=ba261220638dd, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2e845489837, createdName=金朝岁月, createdTime=Wed May 18 11:57:33 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1991946, encodeId=2e0f1991946d7, content=<a href='/topic/show?id=5a916544314' target=_blank style='color:#2F92EE;'>#浆细胞瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65443, encryptionId=5a916544314, topicName=浆细胞瘤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfab443, createdName=saikp, createdTime=Wed Jul 17 15:55:00 CST 2019, time=2019-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1821548, encodeId=4412182154877, content=<a href='/topic/show?id=35f5101638fb' target=_blank style='color:#2F92EE;'>#骨孤立性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101638, encryptionId=35f5101638fb, topicName=骨孤立性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1dfd2500156, createdName=12498c24m69暂无昵称, createdTime=Sat Jul 27 19:55:00 CST 2019, time=2019-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1254243, encodeId=974f12542434c, content=<a href='/topic/show?id=f30ae86297d' target=_blank style='color:#2F92EE;'>#结核#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78629, encryptionId=f30ae86297d, topicName=结核)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=huhuaidong387, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1466616, encodeId=b3e1146661698, content=<a href='/topic/show?id=8d3e65434d4' target=_blank style='color:#2F92EE;'>#浆细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65434, encryptionId=8d3e65434d4, topicName=浆细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=181c6846356, createdName=huangshifeng, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1475943, encodeId=919f14e5943a4, content=<a href='/topic/show?id=2bcee797732' target=_blank style='color:#2F92EE;'>#细胞瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77977, encryptionId=2bcee797732, topicName=细胞瘤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智智灵药, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1525631, encodeId=b440152563121, content=<a href='/topic/show?id=2ef14545092' target=_blank style='color:#2F92EE;'>#孤立性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45450, encryptionId=2ef14545092, topicName=孤立性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cdb511649913, createdName=jxrzshh, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1589492, encodeId=ea621589492d1, content=<a href='/topic/show?id=ec4584551b2' target=_blank style='color:#2F92EE;'>#脊柱结核#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84551, encryptionId=ec4584551b2, topicName=脊柱结核)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a42d17732962, createdName=3631179, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=353638, encodeId=8ae3353638d8, content=好文,值得点赞!认真学习了,把经验应用于实践,为患者解除病痛。, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Sun Nov 25 15:03:31 CST 2018, time=2018-11-25, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1220638, encodeId=ba261220638dd, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2e845489837, createdName=金朝岁月, createdTime=Wed May 18 11:57:33 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1991946, encodeId=2e0f1991946d7, content=<a href='/topic/show?id=5a916544314' target=_blank style='color:#2F92EE;'>#浆细胞瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65443, encryptionId=5a916544314, topicName=浆细胞瘤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfab443, createdName=saikp, createdTime=Wed Jul 17 15:55:00 CST 2019, time=2019-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1821548, encodeId=4412182154877, content=<a href='/topic/show?id=35f5101638fb' target=_blank style='color:#2F92EE;'>#骨孤立性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101638, encryptionId=35f5101638fb, topicName=骨孤立性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1dfd2500156, createdName=12498c24m69暂无昵称, createdTime=Sat Jul 27 19:55:00 CST 2019, time=2019-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1254243, encodeId=974f12542434c, content=<a href='/topic/show?id=f30ae86297d' target=_blank style='color:#2F92EE;'>#结核#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78629, encryptionId=f30ae86297d, topicName=结核)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=huhuaidong387, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1466616, encodeId=b3e1146661698, content=<a href='/topic/show?id=8d3e65434d4' target=_blank style='color:#2F92EE;'>#浆细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65434, encryptionId=8d3e65434d4, topicName=浆细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=181c6846356, createdName=huangshifeng, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1475943, encodeId=919f14e5943a4, content=<a href='/topic/show?id=2bcee797732' target=_blank style='color:#2F92EE;'>#细胞瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77977, encryptionId=2bcee797732, topicName=细胞瘤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智智灵药, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1525631, encodeId=b440152563121, content=<a href='/topic/show?id=2ef14545092' target=_blank style='color:#2F92EE;'>#孤立性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45450, encryptionId=2ef14545092, topicName=孤立性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cdb511649913, createdName=jxrzshh, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1589492, encodeId=ea621589492d1, content=<a href='/topic/show?id=ec4584551b2' target=_blank style='color:#2F92EE;'>#脊柱结核#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84551, encryptionId=ec4584551b2, topicName=脊柱结核)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a42d17732962, createdName=3631179, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=353638, encodeId=8ae3353638d8, content=好文,值得点赞!认真学习了,把经验应用于实践,为患者解除病痛。, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Sun Nov 25 15:03:31 CST 2018, time=2018-11-25, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=1220638, encodeId=ba261220638dd, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2e845489837, createdName=金朝岁月, createdTime=Wed May 18 11:57:33 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1991946, encodeId=2e0f1991946d7, content=<a href='/topic/show?id=5a916544314' target=_blank style='color:#2F92EE;'>#浆细胞瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65443, encryptionId=5a916544314, topicName=浆细胞瘤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfab443, createdName=saikp, createdTime=Wed Jul 17 15:55:00 CST 2019, time=2019-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1821548, encodeId=4412182154877, content=<a href='/topic/show?id=35f5101638fb' target=_blank style='color:#2F92EE;'>#骨孤立性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101638, encryptionId=35f5101638fb, topicName=骨孤立性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1dfd2500156, createdName=12498c24m69暂无昵称, createdTime=Sat Jul 27 19:55:00 CST 2019, time=2019-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1254243, encodeId=974f12542434c, content=<a href='/topic/show?id=f30ae86297d' target=_blank style='color:#2F92EE;'>#结核#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78629, encryptionId=f30ae86297d, topicName=结核)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=huhuaidong387, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1466616, encodeId=b3e1146661698, content=<a href='/topic/show?id=8d3e65434d4' target=_blank style='color:#2F92EE;'>#浆细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65434, encryptionId=8d3e65434d4, topicName=浆细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=181c6846356, createdName=huangshifeng, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1475943, encodeId=919f14e5943a4, content=<a href='/topic/show?id=2bcee797732' target=_blank style='color:#2F92EE;'>#细胞瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77977, encryptionId=2bcee797732, topicName=细胞瘤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智智灵药, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1525631, encodeId=b440152563121, content=<a href='/topic/show?id=2ef14545092' target=_blank style='color:#2F92EE;'>#孤立性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45450, encryptionId=2ef14545092, topicName=孤立性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cdb511649913, createdName=jxrzshh, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1589492, encodeId=ea621589492d1, content=<a href='/topic/show?id=ec4584551b2' target=_blank style='color:#2F92EE;'>#脊柱结核#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84551, encryptionId=ec4584551b2, topicName=脊柱结核)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a42d17732962, createdName=3631179, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=353638, encodeId=8ae3353638d8, content=好文,值得点赞!认真学习了,把经验应用于实践,为患者解除病痛。, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Sun Nov 25 15:03:31 CST 2018, time=2018-11-25, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1220638, encodeId=ba261220638dd, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2e845489837, createdName=金朝岁月, createdTime=Wed May 18 11:57:33 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1991946, encodeId=2e0f1991946d7, content=<a href='/topic/show?id=5a916544314' target=_blank style='color:#2F92EE;'>#浆细胞瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65443, encryptionId=5a916544314, topicName=浆细胞瘤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfab443, createdName=saikp, createdTime=Wed Jul 17 15:55:00 CST 2019, time=2019-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1821548, encodeId=4412182154877, content=<a href='/topic/show?id=35f5101638fb' target=_blank style='color:#2F92EE;'>#骨孤立性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101638, encryptionId=35f5101638fb, topicName=骨孤立性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1dfd2500156, createdName=12498c24m69暂无昵称, createdTime=Sat Jul 27 19:55:00 CST 2019, time=2019-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1254243, encodeId=974f12542434c, content=<a href='/topic/show?id=f30ae86297d' target=_blank style='color:#2F92EE;'>#结核#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78629, encryptionId=f30ae86297d, topicName=结核)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=huhuaidong387, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1466616, encodeId=b3e1146661698, content=<a href='/topic/show?id=8d3e65434d4' target=_blank style='color:#2F92EE;'>#浆细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65434, encryptionId=8d3e65434d4, topicName=浆细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=181c6846356, createdName=huangshifeng, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1475943, encodeId=919f14e5943a4, content=<a href='/topic/show?id=2bcee797732' target=_blank style='color:#2F92EE;'>#细胞瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77977, encryptionId=2bcee797732, topicName=细胞瘤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智智灵药, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1525631, encodeId=b440152563121, content=<a href='/topic/show?id=2ef14545092' target=_blank style='color:#2F92EE;'>#孤立性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45450, encryptionId=2ef14545092, topicName=孤立性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cdb511649913, createdName=jxrzshh, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1589492, encodeId=ea621589492d1, content=<a href='/topic/show?id=ec4584551b2' target=_blank style='color:#2F92EE;'>#脊柱结核#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84551, encryptionId=ec4584551b2, topicName=脊柱结核)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a42d17732962, createdName=3631179, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=353638, encodeId=8ae3353638d8, content=好文,值得点赞!认真学习了,把经验应用于实践,为患者解除病痛。, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Sun Nov 25 15:03:31 CST 2018, time=2018-11-25, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1220638, encodeId=ba261220638dd, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2e845489837, createdName=金朝岁月, createdTime=Wed May 18 11:57:33 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1991946, encodeId=2e0f1991946d7, content=<a href='/topic/show?id=5a916544314' target=_blank style='color:#2F92EE;'>#浆细胞瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65443, encryptionId=5a916544314, topicName=浆细胞瘤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfab443, createdName=saikp, createdTime=Wed Jul 17 15:55:00 CST 2019, time=2019-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1821548, encodeId=4412182154877, content=<a href='/topic/show?id=35f5101638fb' target=_blank style='color:#2F92EE;'>#骨孤立性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101638, encryptionId=35f5101638fb, topicName=骨孤立性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1dfd2500156, createdName=12498c24m69暂无昵称, createdTime=Sat Jul 27 19:55:00 CST 2019, time=2019-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1254243, encodeId=974f12542434c, content=<a href='/topic/show?id=f30ae86297d' target=_blank style='color:#2F92EE;'>#结核#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78629, encryptionId=f30ae86297d, topicName=结核)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=huhuaidong387, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1466616, encodeId=b3e1146661698, content=<a href='/topic/show?id=8d3e65434d4' target=_blank style='color:#2F92EE;'>#浆细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65434, encryptionId=8d3e65434d4, topicName=浆细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=181c6846356, createdName=huangshifeng, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1475943, encodeId=919f14e5943a4, content=<a href='/topic/show?id=2bcee797732' target=_blank style='color:#2F92EE;'>#细胞瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77977, encryptionId=2bcee797732, topicName=细胞瘤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智智灵药, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1525631, encodeId=b440152563121, content=<a href='/topic/show?id=2ef14545092' target=_blank style='color:#2F92EE;'>#孤立性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45450, encryptionId=2ef14545092, topicName=孤立性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cdb511649913, createdName=jxrzshh, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1589492, encodeId=ea621589492d1, content=<a href='/topic/show?id=ec4584551b2' target=_blank style='color:#2F92EE;'>#脊柱结核#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84551, encryptionId=ec4584551b2, topicName=脊柱结核)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a42d17732962, createdName=3631179, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=353638, encodeId=8ae3353638d8, content=好文,值得点赞!认真学习了,把经验应用于实践,为患者解除病痛。, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Sun Nov 25 15:03:31 CST 2018, time=2018-11-25, status=1, ipAttribution=)]
  7. [GetPortalCommentsPageByObjectIdResponse(id=1220638, encodeId=ba261220638dd, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2e845489837, createdName=金朝岁月, createdTime=Wed May 18 11:57:33 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1991946, encodeId=2e0f1991946d7, content=<a href='/topic/show?id=5a916544314' target=_blank style='color:#2F92EE;'>#浆细胞瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65443, encryptionId=5a916544314, topicName=浆细胞瘤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfab443, createdName=saikp, createdTime=Wed Jul 17 15:55:00 CST 2019, time=2019-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1821548, encodeId=4412182154877, content=<a href='/topic/show?id=35f5101638fb' target=_blank style='color:#2F92EE;'>#骨孤立性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101638, encryptionId=35f5101638fb, topicName=骨孤立性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1dfd2500156, createdName=12498c24m69暂无昵称, createdTime=Sat Jul 27 19:55:00 CST 2019, time=2019-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1254243, encodeId=974f12542434c, content=<a href='/topic/show?id=f30ae86297d' target=_blank style='color:#2F92EE;'>#结核#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78629, encryptionId=f30ae86297d, topicName=结核)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=huhuaidong387, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1466616, encodeId=b3e1146661698, content=<a href='/topic/show?id=8d3e65434d4' target=_blank style='color:#2F92EE;'>#浆细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65434, encryptionId=8d3e65434d4, topicName=浆细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=181c6846356, createdName=huangshifeng, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1475943, encodeId=919f14e5943a4, content=<a href='/topic/show?id=2bcee797732' target=_blank style='color:#2F92EE;'>#细胞瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77977, encryptionId=2bcee797732, topicName=细胞瘤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智智灵药, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1525631, encodeId=b440152563121, content=<a href='/topic/show?id=2ef14545092' target=_blank style='color:#2F92EE;'>#孤立性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45450, encryptionId=2ef14545092, topicName=孤立性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cdb511649913, createdName=jxrzshh, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1589492, encodeId=ea621589492d1, content=<a href='/topic/show?id=ec4584551b2' target=_blank style='color:#2F92EE;'>#脊柱结核#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84551, encryptionId=ec4584551b2, topicName=脊柱结核)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a42d17732962, createdName=3631179, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=353638, encodeId=8ae3353638d8, content=好文,值得点赞!认真学习了,把经验应用于实践,为患者解除病痛。, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Sun Nov 25 15:03:31 CST 2018, time=2018-11-25, status=1, ipAttribution=)]
    2018-11-27 jxrzshh
  8. [GetPortalCommentsPageByObjectIdResponse(id=1220638, encodeId=ba261220638dd, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2e845489837, createdName=金朝岁月, createdTime=Wed May 18 11:57:33 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1991946, encodeId=2e0f1991946d7, content=<a href='/topic/show?id=5a916544314' target=_blank style='color:#2F92EE;'>#浆细胞瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65443, encryptionId=5a916544314, topicName=浆细胞瘤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfab443, createdName=saikp, createdTime=Wed Jul 17 15:55:00 CST 2019, time=2019-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1821548, encodeId=4412182154877, content=<a href='/topic/show?id=35f5101638fb' target=_blank style='color:#2F92EE;'>#骨孤立性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101638, encryptionId=35f5101638fb, topicName=骨孤立性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1dfd2500156, createdName=12498c24m69暂无昵称, createdTime=Sat Jul 27 19:55:00 CST 2019, time=2019-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1254243, encodeId=974f12542434c, content=<a href='/topic/show?id=f30ae86297d' target=_blank style='color:#2F92EE;'>#结核#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78629, encryptionId=f30ae86297d, topicName=结核)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=huhuaidong387, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1466616, encodeId=b3e1146661698, content=<a href='/topic/show?id=8d3e65434d4' target=_blank style='color:#2F92EE;'>#浆细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65434, encryptionId=8d3e65434d4, topicName=浆细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=181c6846356, createdName=huangshifeng, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1475943, encodeId=919f14e5943a4, content=<a href='/topic/show?id=2bcee797732' target=_blank style='color:#2F92EE;'>#细胞瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77977, encryptionId=2bcee797732, topicName=细胞瘤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智智灵药, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1525631, encodeId=b440152563121, content=<a href='/topic/show?id=2ef14545092' target=_blank style='color:#2F92EE;'>#孤立性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45450, encryptionId=2ef14545092, topicName=孤立性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cdb511649913, createdName=jxrzshh, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1589492, encodeId=ea621589492d1, content=<a href='/topic/show?id=ec4584551b2' target=_blank style='color:#2F92EE;'>#脊柱结核#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84551, encryptionId=ec4584551b2, topicName=脊柱结核)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a42d17732962, createdName=3631179, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=353638, encodeId=8ae3353638d8, content=好文,值得点赞!认真学习了,把经验应用于实践,为患者解除病痛。, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Sun Nov 25 15:03:31 CST 2018, time=2018-11-25, status=1, ipAttribution=)]
  9. [GetPortalCommentsPageByObjectIdResponse(id=1220638, encodeId=ba261220638dd, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2e845489837, createdName=金朝岁月, createdTime=Wed May 18 11:57:33 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1991946, encodeId=2e0f1991946d7, content=<a href='/topic/show?id=5a916544314' target=_blank style='color:#2F92EE;'>#浆细胞瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65443, encryptionId=5a916544314, topicName=浆细胞瘤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfab443, createdName=saikp, createdTime=Wed Jul 17 15:55:00 CST 2019, time=2019-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1821548, encodeId=4412182154877, content=<a href='/topic/show?id=35f5101638fb' target=_blank style='color:#2F92EE;'>#骨孤立性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101638, encryptionId=35f5101638fb, topicName=骨孤立性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1dfd2500156, createdName=12498c24m69暂无昵称, createdTime=Sat Jul 27 19:55:00 CST 2019, time=2019-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1254243, encodeId=974f12542434c, content=<a href='/topic/show?id=f30ae86297d' target=_blank style='color:#2F92EE;'>#结核#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78629, encryptionId=f30ae86297d, topicName=结核)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=huhuaidong387, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1466616, encodeId=b3e1146661698, content=<a href='/topic/show?id=8d3e65434d4' target=_blank style='color:#2F92EE;'>#浆细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65434, encryptionId=8d3e65434d4, topicName=浆细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=181c6846356, createdName=huangshifeng, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1475943, encodeId=919f14e5943a4, content=<a href='/topic/show?id=2bcee797732' target=_blank style='color:#2F92EE;'>#细胞瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77977, encryptionId=2bcee797732, topicName=细胞瘤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智智灵药, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1525631, encodeId=b440152563121, content=<a href='/topic/show?id=2ef14545092' target=_blank style='color:#2F92EE;'>#孤立性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45450, encryptionId=2ef14545092, topicName=孤立性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cdb511649913, createdName=jxrzshh, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1589492, encodeId=ea621589492d1, content=<a href='/topic/show?id=ec4584551b2' target=_blank style='color:#2F92EE;'>#脊柱结核#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84551, encryptionId=ec4584551b2, topicName=脊柱结核)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a42d17732962, createdName=3631179, createdTime=Tue Nov 27 01:55:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=353638, encodeId=8ae3353638d8, content=好文,值得点赞!认真学习了,把经验应用于实践,为患者解除病痛。, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Sun Nov 25 15:03:31 CST 2018, time=2018-11-25, status=1, ipAttribution=)]
    2018-11-25 1dd8a7c5m95(暂无匿称)

    好文,值得点赞!认真学习了,把经验应用于实践,为患者解除病痛。

    0