Hepatology:控制血糖可降低非酒精性脂肪肝肝纤维化风险

2021-05-20 Dr.Sun Nutrition & Health MedSci原创

非酒精性脂肪性肝病(NAFLD)是一种日益严重的流行病,影响全球1/4的人口和大约60%的2型糖尿病(T2D)患者。NAFLD这一术语包括一种疾病谱,从最良性端的孤立脂肪变性,到以脂肪变性、炎症和肝细

非酒精性脂肪性肝病(NAFLD)是一种日益严重的流行病,影响全球1/4的人口和大约60%的2型糖尿病(T2D)患者。NAFLD这一术语包括一种疾病谱,从最良性端的孤立脂肪变性,到以脂肪变性、炎症和肝细胞气球样变为特征的非酒精性脂肪性肝炎(NASH),有或无纤维化。NASH增加了纤维化进展为肝硬化的风险,并增加了肝功能失代偿和肝细胞癌的风险,使NASH成为美国肝移植的主要指征。较高分级的脂肪变性、炎症和肝细胞气球样变使脂肪性肝炎的严重程度增加,进而与渐进性肝纤维化密切相关,后者是肝脏相关发病率和死亡率的主要预测因素。

T2D(2型糖尿病)是NAFLD发展的确定危险因素,是晚期肝纤维化、肝硬化并发症,如肝细胞癌和肝脏相关死亡率的有力预测因素。尽管NAFLD和T2D之间有明确的关联,但人们对血糖控制如何影响组织学严重程度以及NAFLD进展的相关风险知之甚少。虽然降糖药物已被用作NASH的治疗方法,但尚不清楚治疗效果是否归因于此类干预措施的降糖效果。此外,糖尿病患者的肝转氨酶类特别不敏感,经活检证明为NASH的患者有70%以上肝转氨酶类是正常的,这限制了使用疾病活动的非侵入性替代指标来确定血糖降低对NASH的影响的能力。因此,需要研究直接检查血糖控制与NAFLD/NASH肝损伤的组织学特征之间的关联。

近日,发表在Hepatology杂志上的一项研究,来自美国杜克大学的研究人员发现,血糖控制能够预测NAFLD/NASH中肝细胞气球样变和肝纤维化的严重程度,因此优化血糖控制可能是改变与NASH相关的纤维化进展风险的一种手段。

该研究利用杜克NAFLD临床数据库,检查了经活检证明的NAFLD/NASH(n=713)患者,以及肝损伤与通过糖化血红蛋白(HbA1c)测定的血糖控制的关联。研究队列主要为女性(59%)、高加索人(84%),年龄中位数(IQR)为50岁(42,58);49%患有糖尿病(n=348)。采用根据年龄、性别、种族、糖尿病、体重指数和高脂血症调整的广义线性回归模型评估肝活检前一年平均HbA1c与NAFLD/NASH组织学特征严重程度之间的关联。根据NASH临床研究网络(NASH Clinical Research Network)系统对组织学特征进行分级和分期。基于组的轨迹分析用于检查临床指示肝活检前5年内患者≥3 HbA1c(n=298)检测。

研究结果发现:较高的平均HbA1c与更高分级的肝脂肪变性和肝细胞气球样变、而非肝小叶炎症有关。平均HbA1c每增加1%,肝纤维化分级增加的几率就会增加15%(OR 1.15, 95% CI 1.01, 1.31)。与良好的血糖控制相比,中度控制与肝细胞气球样变(OR 1.74, 95% CI 1.01, 3.01, p=0.048)和肝纤维化(OR 4.59, 95% CI 2.33, 9.06, p<0.01)的严重程度增加呈显著相关。

平均HbA1c与更严重肝纤维化分期风险之间的剂量反应关系

RCS方法的剂量响应图表明,平均HbA1c与脂肪变性、肝细胞气球样变和NAS之间关系的相关性是非线性和近似的倒L形曲线。观察到HbA1c与门脉区炎症之间的相关性为V形剂量响应曲线。对于平均HbA1c<7.0%(53 mmol/mol),检测到脂肪变性、肝细胞气球样变和NAS的结果呈线性正相关;这些线性相关的显著性在HbA1c超过7%(53 mmol/mol)时消失。

研究人员观察到HbA1c和纤维化分期之间的线性关联存在于广泛的HbA1c范围内,从大约5到11%(31到97 mmol/mol)。然而,HbA1c与NASH的可能性之间,以及与NASH的其他组织学特征的严重程度(即脂肪变性、气球样变)之间的关联在HbA1c水平过7%(53 mmol/mol)之后减弱。造成这种差异的原因尚不清楚,特别是肝细胞气球样变和肝纤维化之间的差异。

平均 HbA1c 与严重肝脏组织学结果风险之间的剂量反应关系

值得注意的是,证据表明,肝细胞气球样变的严重程度是肝纤维化的有力预测因子。因此,血糖控制与肝细胞气球样变的严重程度和肝纤维化分期的强烈关联支持了T2D是渐进性NAFLD/NASH的有力预测因子的现有知识。

这项研究的主要作者,杜克大学健康内分泌学家Anastasia-Stefania Alexopoulos说,这些发现对糖尿病患者特别重要,因为该患者群体中很大一部分人也患有非酒精性脂肪性肝病。

Alexopoulos还表示,这一发现可能促使临床医生重新考虑他们的糖尿病治疗方法,开出已知既能改善血糖控制,又能促进减肥的糖尿病药物。

Alexopoulos说:“很多时候,对于糖尿病,我们考虑的是心脏病、高血压、胆固醇——我们考虑所有这些并发症,我想将脂肪肝加进来。”

总之,这项研究首次检验了长期血糖控制对NAFLD/NASH组织学结果的影响。研究发现活检前的血糖控制与肝纤维化和肝细胞气球样变的严重程度始终相关。这项研究提供了血糖控制与NASH之间关系的关键见解,这一领域的进一步研究将对糖尿病实践产生重要影响,无论是在为NASH高风险患者提供咨询时,还是在个性化血糖目标时。

原始出处:

Anastasia-Stefania Alexopoulos, Matthew J Crowley et al. Glycemic Control Predicts Severity of Hepatocyte Ballooning and Hepatic Fibrosis in Nonalcoholic Fatty Liver Disease. Hepatology. 2021 Mar 16.  doi: 10.1002/hep.31806.  Online ahead of print.

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  5. [GetPortalCommentsPageByObjectIdResponse(id=1808268, encodeId=66bb1808268b6, content=<a href='/topic/show?id=f94d81342e5' target=_blank style='color:#2F92EE;'>#肝纤维#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81342, encryptionId=f94d81342e5, topicName=肝纤维)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Sun Jan 16 22:48:48 CST 2022, time=2022-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1980595, encodeId=85db19805950b, content=<a href='/topic/show?id=099f9548ed7' target=_blank style='color:#2F92EE;'>#酒精性脂肪肝#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95487, encryptionId=099f9548ed7, topicName=酒精性脂肪肝)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=26a9200, createdName=yangshch, createdTime=Fri Aug 13 13:48:48 CST 2021, time=2021-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1673667, encodeId=b7d316e3667ba, content=<a href='/topic/show?id=757b954e922' target=_blank style='color:#2F92EE;'>#酒精性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95479, encryptionId=757b954e922, topicName=酒精性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=398f26933958, createdName=huiwelcome, createdTime=Fri Nov 26 08:48:48 CST 2021, time=2021-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1934558, encodeId=a1c3193455831, content=<a href='/topic/show?id=b65a56e400e' target=_blank style='color:#2F92EE;'>#控制血糖#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56740, encryptionId=b65a56e400e, topicName=控制血糖)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=71f1477, createdName=s_pl2008, createdTime=Sun Feb 27 19:48:48 CST 2022, time=2022-02-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1066452, encodeId=67a2106645272, content=好内容,谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2020/02/15/7274ed1be4747d648e4e2f7f62fae403.jpg, createdBy=d8d65273314, createdName=1482963am12暂无昵称, createdTime=Wed Nov 03 00:57:09 CST 2021, time=2021-11-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1676639, encodeId=c3f716e66390c, content=<a href='/topic/show?id=397299e19c7' target=_blank style='color:#2F92EE;'>#非酒精性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99719, encryptionId=397299e19c7, topicName=非酒精性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d18c27357544, createdName=Tommy1958, createdTime=Wed Jun 02 09:48:48 CST 2021, time=2021-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1008393, encodeId=fa031008393e0, content=获益, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210806/fd684fe8990b45b491079e7402430e5c/172e645274a3412dada3473697e1344b.jpg, createdBy=020b5427427, createdName=imnfish, createdTime=Mon Aug 16 18:07:44 CST 2021, time=2021-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1427519, encodeId=7568142e519a8, content=<a href='/topic/show?id=221d685172' target=_blank style='color:#2F92EE;'>#EPA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, 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=Sat May 22 03:48:48 CST 2021, time=2021-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=967263, encodeId=20d696e263f8, content=好文章!, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Thu May 20 16:34:59 CST 2021, time=2021-05-20, status=1, ipAttribution=)]
    2021-11-03 1482963am12暂无昵称

    好内容,谢谢

    0

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  7. [GetPortalCommentsPageByObjectIdResponse(id=1808268, encodeId=66bb1808268b6, content=<a href='/topic/show?id=f94d81342e5' target=_blank style='color:#2F92EE;'>#肝纤维#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81342, encryptionId=f94d81342e5, topicName=肝纤维)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Sun Jan 16 22:48:48 CST 2022, time=2022-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1980595, encodeId=85db19805950b, content=<a href='/topic/show?id=099f9548ed7' target=_blank style='color:#2F92EE;'>#酒精性脂肪肝#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95487, encryptionId=099f9548ed7, topicName=酒精性脂肪肝)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=26a9200, createdName=yangshch, createdTime=Fri Aug 13 13:48:48 CST 2021, time=2021-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1673667, encodeId=b7d316e3667ba, content=<a href='/topic/show?id=757b954e922' target=_blank style='color:#2F92EE;'>#酒精性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95479, encryptionId=757b954e922, topicName=酒精性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=398f26933958, createdName=huiwelcome, createdTime=Fri Nov 26 08:48:48 CST 2021, time=2021-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1934558, encodeId=a1c3193455831, content=<a href='/topic/show?id=b65a56e400e' target=_blank style='color:#2F92EE;'>#控制血糖#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56740, encryptionId=b65a56e400e, topicName=控制血糖)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=71f1477, createdName=s_pl2008, createdTime=Sun Feb 27 19:48:48 CST 2022, time=2022-02-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1066452, encodeId=67a2106645272, content=好内容,谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2020/02/15/7274ed1be4747d648e4e2f7f62fae403.jpg, createdBy=d8d65273314, createdName=1482963am12暂无昵称, createdTime=Wed Nov 03 00:57:09 CST 2021, time=2021-11-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1676639, encodeId=c3f716e66390c, content=<a href='/topic/show?id=397299e19c7' target=_blank style='color:#2F92EE;'>#非酒精性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99719, encryptionId=397299e19c7, topicName=非酒精性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d18c27357544, createdName=Tommy1958, createdTime=Wed Jun 02 09:48:48 CST 2021, time=2021-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1008393, encodeId=fa031008393e0, content=获益, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210806/fd684fe8990b45b491079e7402430e5c/172e645274a3412dada3473697e1344b.jpg, createdBy=020b5427427, createdName=imnfish, createdTime=Mon Aug 16 18:07:44 CST 2021, time=2021-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1427519, encodeId=7568142e519a8, content=<a href='/topic/show?id=221d685172' target=_blank style='color:#2F92EE;'>#EPA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, 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=Sat May 22 03:48:48 CST 2021, time=2021-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=967263, encodeId=20d696e263f8, content=好文章!, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Thu May 20 16:34:59 CST 2021, time=2021-05-20, status=1, ipAttribution=)]
    2021-08-16 imnfish

    获益

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1808268, encodeId=66bb1808268b6, content=<a href='/topic/show?id=f94d81342e5' target=_blank style='color:#2F92EE;'>#肝纤维#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81342, encryptionId=f94d81342e5, topicName=肝纤维)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Sun Jan 16 22:48:48 CST 2022, time=2022-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1980595, encodeId=85db19805950b, content=<a href='/topic/show?id=099f9548ed7' target=_blank style='color:#2F92EE;'>#酒精性脂肪肝#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95487, encryptionId=099f9548ed7, topicName=酒精性脂肪肝)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=26a9200, createdName=yangshch, createdTime=Fri Aug 13 13:48:48 CST 2021, time=2021-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1673667, encodeId=b7d316e3667ba, content=<a href='/topic/show?id=757b954e922' target=_blank style='color:#2F92EE;'>#酒精性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95479, encryptionId=757b954e922, topicName=酒精性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=398f26933958, createdName=huiwelcome, createdTime=Fri Nov 26 08:48:48 CST 2021, time=2021-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1934558, encodeId=a1c3193455831, content=<a href='/topic/show?id=b65a56e400e' target=_blank style='color:#2F92EE;'>#控制血糖#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56740, encryptionId=b65a56e400e, topicName=控制血糖)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=71f1477, createdName=s_pl2008, createdTime=Sun Feb 27 19:48:48 CST 2022, time=2022-02-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1066452, encodeId=67a2106645272, content=好内容,谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2020/02/15/7274ed1be4747d648e4e2f7f62fae403.jpg, createdBy=d8d65273314, createdName=1482963am12暂无昵称, createdTime=Wed Nov 03 00:57:09 CST 2021, time=2021-11-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1676639, encodeId=c3f716e66390c, content=<a href='/topic/show?id=397299e19c7' target=_blank style='color:#2F92EE;'>#非酒精性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99719, encryptionId=397299e19c7, topicName=非酒精性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d18c27357544, createdName=Tommy1958, createdTime=Wed Jun 02 09:48:48 CST 2021, time=2021-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1008393, encodeId=fa031008393e0, content=获益, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210806/fd684fe8990b45b491079e7402430e5c/172e645274a3412dada3473697e1344b.jpg, createdBy=020b5427427, createdName=imnfish, createdTime=Mon Aug 16 18:07:44 CST 2021, time=2021-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1427519, encodeId=7568142e519a8, content=<a href='/topic/show?id=221d685172' target=_blank style='color:#2F92EE;'>#EPA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, 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=Sat May 22 03:48:48 CST 2021, time=2021-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=967263, encodeId=20d696e263f8, content=好文章!, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Thu May 20 16:34:59 CST 2021, time=2021-05-20, status=1, ipAttribution=)]
    2021-05-22 gwc384
  9. [GetPortalCommentsPageByObjectIdResponse(id=1808268, encodeId=66bb1808268b6, content=<a href='/topic/show?id=f94d81342e5' target=_blank style='color:#2F92EE;'>#肝纤维#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81342, encryptionId=f94d81342e5, topicName=肝纤维)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Sun Jan 16 22:48:48 CST 2022, time=2022-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1980595, encodeId=85db19805950b, content=<a href='/topic/show?id=099f9548ed7' target=_blank style='color:#2F92EE;'>#酒精性脂肪肝#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95487, encryptionId=099f9548ed7, topicName=酒精性脂肪肝)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=26a9200, createdName=yangshch, createdTime=Fri Aug 13 13:48:48 CST 2021, time=2021-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1673667, encodeId=b7d316e3667ba, content=<a href='/topic/show?id=757b954e922' target=_blank style='color:#2F92EE;'>#酒精性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95479, encryptionId=757b954e922, topicName=酒精性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=398f26933958, createdName=huiwelcome, createdTime=Fri Nov 26 08:48:48 CST 2021, time=2021-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1934558, encodeId=a1c3193455831, content=<a href='/topic/show?id=b65a56e400e' target=_blank style='color:#2F92EE;'>#控制血糖#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56740, encryptionId=b65a56e400e, topicName=控制血糖)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=71f1477, createdName=s_pl2008, createdTime=Sun Feb 27 19:48:48 CST 2022, time=2022-02-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1066452, encodeId=67a2106645272, content=好内容,谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2020/02/15/7274ed1be4747d648e4e2f7f62fae403.jpg, createdBy=d8d65273314, createdName=1482963am12暂无昵称, createdTime=Wed Nov 03 00:57:09 CST 2021, time=2021-11-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1676639, encodeId=c3f716e66390c, content=<a href='/topic/show?id=397299e19c7' target=_blank style='color:#2F92EE;'>#非酒精性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99719, encryptionId=397299e19c7, topicName=非酒精性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d18c27357544, createdName=Tommy1958, createdTime=Wed Jun 02 09:48:48 CST 2021, time=2021-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1008393, encodeId=fa031008393e0, content=获益, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210806/fd684fe8990b45b491079e7402430e5c/172e645274a3412dada3473697e1344b.jpg, createdBy=020b5427427, createdName=imnfish, createdTime=Mon Aug 16 18:07:44 CST 2021, time=2021-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1427519, encodeId=7568142e519a8, content=<a href='/topic/show?id=221d685172' target=_blank style='color:#2F92EE;'>#EPA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, 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=Sat May 22 03:48:48 CST 2021, time=2021-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=967263, encodeId=20d696e263f8, content=好文章!, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Thu May 20 16:34:59 CST 2021, time=2021-05-20, status=1, ipAttribution=)]
    2021-05-20 jyzxjiangqin

    好文章!

    0

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