JAMA:血管内治疗前经静脉使用替罗非班并不显著改善大血管闭塞性卒中患者的临床结局(RESCUE BT研究)

2022-08-10 MedSci原创 MedSci原创

血管内治疗毋庸置疑是急性前循环大血管闭塞的一线治疗手段。然而,不论是采用支架取栓、导管抽吸,亦或是机械碎栓、血管成形等技术,都有可能损害血管内皮,致使血栓形成,甚者发生血管再次闭塞。既往研究报道术后2

血管内治疗毋庸置疑是急性前循环大血管闭塞的一线治疗手段。然而,不论是采用支架取栓、导管抽吸,亦或是机械碎栓、血管成形等技术,都有可能损害血管内皮,致使血栓形成,甚者发生血管再次闭塞。既往研究报道术后24小时内发生血管再闭的概率达3%-18%。一种可行的预防方式是使用抗血小板药物辅助血管内治疗。

替罗非班是一种具有高选择性和高亲和力的非肽类GP IIb/IIIa受体抑制剂,其分子量小,起效速度快,可逆性抑制血小板聚集。在急性冠脉综合征诊疗中,替罗非班已被证明能够有效减少PCI并发血栓性事件的风险。但在急性卒中血管内治疗领域,替罗非班的作用少有报道,仅有的分析局限于回顾性、小样本的单中心观察性研究,研究结果间存在较大异质性,尚无随机对照试验的循证支持。

急性大血管闭塞血管内治疗前静脉使用替罗非班的多中心、随机、安慰剂对照、双盲临床试验(RESCUE BT)是由陆军军医大学第二附属医院(重庆市新桥医院)神经内科医学中心杨清武教授和资文杰教授团队联合全国54家医院协同开展,是全球首个探讨静脉使用替罗非班是否可以进一步改善接受血管内治疗急性前循环大血管闭塞患者临床结局的大规模随机对照临床试验。试验结果于北京时间2022年08月09日在JAMA《美国医学会杂志》发表。

研究背景

脑卒中是我国首位致死致残疾病,每年新发卒中患者超过380万人,导致约115万人死亡,急性大血管闭塞性卒中占比仅20%,但致死致残率高达60%,给国家和家庭造成极其沉重的社会及经济负担。2015年国内外卒中早期管理指南一致推荐血管内治疗作为急性大血管闭塞的首选治疗方法。然而,各种血管内治疗方式均可能损伤血管内皮细胞,引发血小板活化、黏附和集聚,导致血管再闭塞及其他血栓性并发症。

替罗非班是一种非肽类血小板糖蛋白IIb/IIIa受体拮抗剂。目前已有很多学者研究报道了替罗非班作为血管内治疗的重要辅助治疗手段在急性缺血性卒中中的作用。然而,大部分研究为小样本、单中心观察性研究,尚无随机对照试验探讨这一临床医师非常感兴趣的关键问题。

RESCUE BT试验聚焦当前脑卒中救治领域中的临床重大问题——替罗非班是否可以减轻接受血管内治疗急性前循环大血管闭塞性卒中患者残疾严重程度。本试验受到鲁南制药集团有限公司全力支持,以及国家自然科学基金和陆军军医大学临床科研人才培养计划等多个项目资助。

研究方法

主要纳入标准: 年龄≥18岁;到院距离最后正常时间24小时内;因为存在禁忌症或者家属拒绝等原因未接受静脉溶栓;基线NIHSS评分≤30分;基线ASPECTS≥6分; CTA、MRA或者DSA证实存在颈内动脉颅内段或者大脑中动脉M1段、M2段闭塞;经临床诊疗小组评估拟行血管内治疗。排除标准包括此次脑梗发病1周内使用过双联抗血小板药物、发病2周内曾进行过大型手术、此次发病接受了溶栓治疗等情况。

符合条件的患者按照NIHSS评分、血管闭塞部位、研究中心分层,并被随机分配到试验组或对照组。试验组接受10𝜇g/kg的替罗非班团注,随后按照0.15𝜇g/kg/h维持24小时;对照组接受相同剂量的安慰剂治疗。动脉内治疗采用的具体技术由治疗医生决定,但是不建议使用动脉内溶栓药物(如阿替普酶、尿激酶、研究药物(study drug)、挽救药物(rescue drug)或者其他GP IIb/IIIa抑制剂)。对于进行了球囊扩张、支架植入等挽救治疗(rescue therapy)的患者,若在血管成形术后其正向血流仍然不能维持,挽救药物,也就是研究套装(study kits)中第二瓶药物瓶可以启用。具体的用法同研究药物。

研究药物启用后的第20小时,所有患者接受口服抗血小板药物治疗。研究药物启用后的第24小时,研究药物的静脉维持结束。其后的治疗遵循现有的临床指南。

主要结局指标为90天mRS,安全性结局为症状性颅内出血、90天的死亡率。

主要结果:

从2018年10月至2021年10月,中国的55家具有血管内治疗能力的医院共筛选了1970名患者,其中950人进行了随机, 2人撤回同意,主要分析分别纳入试验组和对照组各463人、485人。平均年龄为67岁,女性占比41.2%,948 名(100%)完成了试验。两组在基线具有较好的均衡性,基线NIHSS评分中位数均为16分,基线ASPECTS评分中位数为8分。值得注意的是,根据卒中TOAST分型,两组均有较高的大动脉粥样硬化型(LAA)卒中比例,分别占比42.6%和49.1%,这可能与亚洲人群的特点相关。

替罗非班组与安慰剂组的90天mRS评分没有显著差异,中位数(四分位数)均为3(1-4),矫正后cOR值为1.09 (95% CI, 0.87-1.37; P=0.46)。同样的,在90天mRS评分0-2分、最后一次血管造影的成功再通率以及48小时血管再通率等次要结局中,两组也不存在统计学差异。 替罗非班与安慰剂相比,较低残疾水平的调整后共同优势比为 1.08(95% CI,0.86-1.36)。

然而,替罗非班组较安慰剂组具有更高的任何颅内出血事件的发生风险(34.9% vs 28.0%, P=0.02),和更高的症状性颅内出血的趋势(9.7% vs 6.4%, P=0.06)。亚组分析显示,替罗非班对预后的作用可能受卒中TOAST分型的调节,对于大动脉粥样硬化型患者,替罗非班相较安慰剂组显示出更佳的90天mRS评分(acOR 1.43; 95% CI 1.02-2.00),在其他亚型中没有观察到这个现象。

研究结论

研究意向性治疗分析结果表明血管内治疗前经静脉使用替罗非班并不显著改善大血管闭塞性卒中患者的临床结局,但亚组分析提示大动脉粥样硬化型卒中可能获益于静脉替罗非班治疗。

RESCUE BT研究显示静脉使用替罗非班用于急性大血管闭塞性脑梗的辅助治疗时,没有改善总人群的功能预后,反而增加了任何颅内出血的风险,并具有潜在增加症状性颅内出血的可能。但对于大动脉粥样硬化型卒中亚群,替罗非班的使用可能会改善临床结局。此假设有待进一步的研究验证。

试验结果表明,不是所有的大血管闭塞性卒中患者都可以接受静脉替罗非班治疗,而大动脉粥样硬化型卒中患者若无明显禁忌症,可以考虑接受静脉替罗非班联合血管内治疗。本试验为急性重型卒中救治使用替罗非班提供有力数据支撑。

致谢

在此,我们衷心地感谢所有合作中心负责人和研究具体执行者,以及所有参研患者及其家属!感谢你们对RESCUE BT研究的无私奉献!感谢你们对新桥卒中临床研究的一贯支持!你们辛苦了!

RESCUE BT研究结束了,但我们坚持做有用研究的初心未改,秉承开放、包容、团结、共赢的合作理念不变,我们的征程还在继续……诚邀各位专家加入我们团队,为优化脑卒中救治,改变临床实践贡献我们的力量。

关于杨清武教授

杨清武,男,主任医师,教授,医学博士,神经内科主任,博士生研究生导师。

陆军军医大学教学明星。主要临床和科研方向为脑血管病。现任重庆市抗癫痫学会理事,国家自然基金委生命科学部同行评议专家,国家食品药品监督管理局新药评审专家,担任解剖与临床杂志、检验医学与临床杂志编委,生物工程与临床杂志特邀编委,并担任Circulation,stroke,JNeuroscience,Research等国内外耳多家SCI收录杂志审稿人,2008年入选医院首批“1135”优秀人才工程,同年入选国家公派留学人员,2009年获得军队有些人才岗位津贴,以第一负责人主持国家、省部级科研课题10余项;以第一作者发表论文30余篇,国外SCI收录论文14篇,获得国家发明专利2项,实用新型专利1项,获重庆市科技进步一等奖一项,军队科技进步三等奖一项。主编专著1部,副主编专著4部。

杨清武参加高考是在1989年,走进了川北医学院临床医学系。1996年,他考入第三军医大学(现陆军军医大学),同年参军入伍,并先后于1999年和2002年获得医学硕士、博士学位。 

资文杰教授

陆军军医大学第二附属医院神经医学中心主任助理、副主任医师、博士、博士后,临床研究团队PI;

重庆市卒中学会急救医学专委会主委,重庆市卒中学会脑血管介入及急诊介入专委会秘书长等;擅长脑血管病的介入诊治及脑血管病多中心临床研究;

以执行PI参与BASILAR、DEVT、RESCUE-BT、ASSIST等多中心RCT,研究成果在JAMA Neurol、Stroke、EJN、JNIS、AJNR等发表SCI论文20余篇;

主持国家自然基金1项,博士后科学基金1项,重庆市卫生适宜技术推广项目1项,陆军军医大学临床研究项目1项,重庆市重大疾病攻关项目1项。

原始出处:

RESCUE BT Trial Investigators, Qiu Z, Li F, Sang H, Luo W, Liu S, Liu W, Guo Z, Li H, Sun D, Huang W, Zhang M, Zhang M, Dai W, Zhou P, Deng W, Zhou Z, Huang X, Lei B, Li J, Yuan Z, Song B, Miao J, Liu S, Jin Z, Zeng G, Zeng H, Yuan J, Wen C, Yu Y, Yuan G, Wu J, Long C, Luo J, Tian Z, Zheng C, Hu Z, Wang S, Wang T, Qi L, Li R, Wan Y, Ke Y, Wu Y, Zhu X, Kong W, Huang J, Peng D, Chang M, Ge H, Shi Z, Yan Z, Du J, Jin Y, Ju D, Huang C, Hong Y, Liu T, Zhao W, Wang J, Zheng B, Wang L, Liu S, Luo X, Luo S, Xu X, Hu J, Pu J, Chen S, Sun Y, Jiang S, Wei L, Fu X, Bai Y, Yang S, Hu W, Zhang G, Pan C, Zhang S, Wang Y, Cao W, Yang S, Zhang J, Guo F, Wen H, Zhang J, Song J, Yue C, Li L, Wu D, Tian Y, Yang J, Lu M, Saver JL, Nogueira RG, Zi W, Yang Q.Effect of Intravenous Tirofiban vs Placebo Before Endovascular Thrombectomy on Functional Outcomes in Large Vessel Occlusion Stroke: The RESCUE BT Randomized Clinical Trial.JAMA. 2022 Aug 9;328(6):543-553. doi: 10.1001/jama.2022.12584

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#插入话题
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  2. [GetPortalCommentsPageByObjectIdResponse(id=2009894, encodeId=03ff2009894d5, content=<a href='/topic/show?id=467789803a9' target=_blank style='color:#2F92EE;'>#血管闭塞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89803, encryptionId=467789803a9, topicName=血管闭塞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=827b160, createdName=cnxcy, createdTime=Wed Jul 12 05:17:11 CST 2023, time=2023-07-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1843296, encodeId=4516184329649, content=<a href='/topic/show?id=3d052296e4e' target=_blank style='color:#2F92EE;'>#临床结局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22967, encryptionId=3d052296e4e, topicName=临床结局)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7fbd46, createdName=mei531, createdTime=Sun Aug 28 08:17:11 CST 2022, time=2022-08-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1720473, encodeId=56991e204739c, content=<a href='/topic/show?id=915c3604e6b' target=_blank style='color:#2F92EE;'>#卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36047, encryptionId=915c3604e6b, topicName=卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=940232842333, createdName=wangyang7969, createdTime=Fri Nov 11 15:17:11 CST 2022, time=2022-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1815202, encodeId=56941815202dd, content=<a href='/topic/show?id=5f519e1848c' target=_blank style='color:#2F92EE;'>#闭塞性卒中#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97184, encryptionId=5f519e1848c, topicName=闭塞性卒中)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf1d2500084, createdName=1249884fm87暂无昵称, createdTime=Mon Jan 16 08:17:11 CST 2023, time=2023-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1706201, encodeId=84441e062019a, content=<a href='/topic/show?id=7f6443986ec' target=_blank style='color:#2F92EE;'>#大血管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43986, encryptionId=7f6443986ec, topicName=大血管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=caff31165455, createdName=kkunny, createdTime=Sun Apr 16 00:17:11 CST 2023, time=2023-04-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1241724, encodeId=f1821241e24a7, content=<a href='/topic/show?id=432089534a8' target=_blank style='color:#2F92EE;'>#血管内治疗#</a>前经静脉使用<a href='/topic/show?id=ae20603536e' target=_blank style='color:#2F92EE;'>#替罗非班#</a>并不显著改善<a href='/topic/show?id=69df4400040' target=_blank style='color:#2F92EE;'>#大血管闭塞性卒中#</a>患者的临床结局。其实替罗非班这一类药物本早应该就淘汰了,无论从机制,还是哪种说法,没有太大的作用。, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89534, encryptionId=432089534a8, topicName=血管内治疗), TopicDto(id=60353, encryptionId=ae20603536e, topicName=替罗非班), TopicDto(id=44000, encryptionId=69df4400040, topicName=大血管闭塞性卒中)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=循证小兵, createdTime=Mon Aug 29 02:48:52 CST 2022, time=2022-08-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1698414, encodeId=448816984149c, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Thu Mar 16 20:17:11 CST 2023, time=2023-03-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1243644, encodeId=d333124364439, content=JAMA上文章都是顶级的,谢谢梅斯及时上新, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=肿瘤克星, createdTime=Wed Aug 10 05:17:11 CST 2022, time=2022-08-10, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=2009894, encodeId=03ff2009894d5, content=<a href='/topic/show?id=467789803a9' target=_blank style='color:#2F92EE;'>#血管闭塞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89803, encryptionId=467789803a9, topicName=血管闭塞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=827b160, createdName=cnxcy, createdTime=Wed Jul 12 05:17:11 CST 2023, time=2023-07-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1843296, encodeId=4516184329649, content=<a href='/topic/show?id=3d052296e4e' target=_blank style='color:#2F92EE;'>#临床结局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22967, encryptionId=3d052296e4e, topicName=临床结局)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7fbd46, createdName=mei531, createdTime=Sun Aug 28 08:17:11 CST 2022, time=2022-08-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1720473, encodeId=56991e204739c, content=<a href='/topic/show?id=915c3604e6b' target=_blank style='color:#2F92EE;'>#卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36047, encryptionId=915c3604e6b, topicName=卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=940232842333, createdName=wangyang7969, createdTime=Fri Nov 11 15:17:11 CST 2022, time=2022-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1815202, encodeId=56941815202dd, content=<a href='/topic/show?id=5f519e1848c' target=_blank style='color:#2F92EE;'>#闭塞性卒中#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97184, encryptionId=5f519e1848c, topicName=闭塞性卒中)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf1d2500084, createdName=1249884fm87暂无昵称, createdTime=Mon Jan 16 08:17:11 CST 2023, time=2023-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1706201, encodeId=84441e062019a, content=<a href='/topic/show?id=7f6443986ec' target=_blank style='color:#2F92EE;'>#大血管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43986, encryptionId=7f6443986ec, topicName=大血管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=caff31165455, createdName=kkunny, createdTime=Sun Apr 16 00:17:11 CST 2023, time=2023-04-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1241724, encodeId=f1821241e24a7, content=<a href='/topic/show?id=432089534a8' target=_blank style='color:#2F92EE;'>#血管内治疗#</a>前经静脉使用<a href='/topic/show?id=ae20603536e' target=_blank style='color:#2F92EE;'>#替罗非班#</a>并不显著改善<a href='/topic/show?id=69df4400040' target=_blank style='color:#2F92EE;'>#大血管闭塞性卒中#</a>患者的临床结局。其实替罗非班这一类药物本早应该就淘汰了,无论从机制,还是哪种说法,没有太大的作用。, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89534, encryptionId=432089534a8, topicName=血管内治疗), TopicDto(id=60353, encryptionId=ae20603536e, topicName=替罗非班), TopicDto(id=44000, encryptionId=69df4400040, topicName=大血管闭塞性卒中)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=循证小兵, createdTime=Mon Aug 29 02:48:52 CST 2022, time=2022-08-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1698414, encodeId=448816984149c, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Thu Mar 16 20:17:11 CST 2023, time=2023-03-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1243644, encodeId=d333124364439, content=JAMA上文章都是顶级的,谢谢梅斯及时上新, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=肿瘤克星, createdTime=Wed Aug 10 05:17:11 CST 2022, time=2022-08-10, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=2009894, encodeId=03ff2009894d5, content=<a href='/topic/show?id=467789803a9' target=_blank style='color:#2F92EE;'>#血管闭塞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89803, encryptionId=467789803a9, topicName=血管闭塞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=827b160, createdName=cnxcy, createdTime=Wed Jul 12 05:17:11 CST 2023, time=2023-07-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1843296, encodeId=4516184329649, content=<a href='/topic/show?id=3d052296e4e' target=_blank style='color:#2F92EE;'>#临床结局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22967, encryptionId=3d052296e4e, topicName=临床结局)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7fbd46, createdName=mei531, createdTime=Sun Aug 28 08:17:11 CST 2022, time=2022-08-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1720473, encodeId=56991e204739c, content=<a href='/topic/show?id=915c3604e6b' target=_blank style='color:#2F92EE;'>#卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36047, encryptionId=915c3604e6b, topicName=卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=940232842333, createdName=wangyang7969, createdTime=Fri Nov 11 15:17:11 CST 2022, time=2022-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1815202, encodeId=56941815202dd, content=<a href='/topic/show?id=5f519e1848c' target=_blank style='color:#2F92EE;'>#闭塞性卒中#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97184, encryptionId=5f519e1848c, topicName=闭塞性卒中)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf1d2500084, createdName=1249884fm87暂无昵称, createdTime=Mon Jan 16 08:17:11 CST 2023, time=2023-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1706201, encodeId=84441e062019a, content=<a href='/topic/show?id=7f6443986ec' target=_blank style='color:#2F92EE;'>#大血管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43986, encryptionId=7f6443986ec, topicName=大血管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=caff31165455, createdName=kkunny, createdTime=Sun Apr 16 00:17:11 CST 2023, time=2023-04-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1241724, encodeId=f1821241e24a7, content=<a href='/topic/show?id=432089534a8' target=_blank style='color:#2F92EE;'>#血管内治疗#</a>前经静脉使用<a href='/topic/show?id=ae20603536e' target=_blank style='color:#2F92EE;'>#替罗非班#</a>并不显著改善<a href='/topic/show?id=69df4400040' target=_blank style='color:#2F92EE;'>#大血管闭塞性卒中#</a>患者的临床结局。其实替罗非班这一类药物本早应该就淘汰了,无论从机制,还是哪种说法,没有太大的作用。, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89534, encryptionId=432089534a8, topicName=血管内治疗), TopicDto(id=60353, encryptionId=ae20603536e, topicName=替罗非班), TopicDto(id=44000, encryptionId=69df4400040, topicName=大血管闭塞性卒中)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=循证小兵, createdTime=Mon Aug 29 02:48:52 CST 2022, time=2022-08-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1698414, encodeId=448816984149c, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Thu Mar 16 20:17:11 CST 2023, time=2023-03-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1243644, encodeId=d333124364439, content=JAMA上文章都是顶级的,谢谢梅斯及时上新, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=肿瘤克星, createdTime=Wed Aug 10 05:17:11 CST 2022, time=2022-08-10, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=2009894, encodeId=03ff2009894d5, content=<a href='/topic/show?id=467789803a9' target=_blank style='color:#2F92EE;'>#血管闭塞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89803, encryptionId=467789803a9, topicName=血管闭塞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=827b160, createdName=cnxcy, createdTime=Wed Jul 12 05:17:11 CST 2023, time=2023-07-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1843296, encodeId=4516184329649, content=<a href='/topic/show?id=3d052296e4e' target=_blank style='color:#2F92EE;'>#临床结局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22967, encryptionId=3d052296e4e, topicName=临床结局)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7fbd46, createdName=mei531, createdTime=Sun Aug 28 08:17:11 CST 2022, time=2022-08-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1720473, encodeId=56991e204739c, content=<a href='/topic/show?id=915c3604e6b' target=_blank style='color:#2F92EE;'>#卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36047, encryptionId=915c3604e6b, topicName=卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=940232842333, createdName=wangyang7969, createdTime=Fri Nov 11 15:17:11 CST 2022, time=2022-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1815202, encodeId=56941815202dd, content=<a href='/topic/show?id=5f519e1848c' target=_blank style='color:#2F92EE;'>#闭塞性卒中#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97184, encryptionId=5f519e1848c, topicName=闭塞性卒中)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf1d2500084, createdName=1249884fm87暂无昵称, createdTime=Mon Jan 16 08:17:11 CST 2023, time=2023-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1706201, encodeId=84441e062019a, content=<a href='/topic/show?id=7f6443986ec' target=_blank style='color:#2F92EE;'>#大血管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43986, encryptionId=7f6443986ec, topicName=大血管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=caff31165455, createdName=kkunny, createdTime=Sun Apr 16 00:17:11 CST 2023, time=2023-04-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1241724, encodeId=f1821241e24a7, content=<a href='/topic/show?id=432089534a8' target=_blank style='color:#2F92EE;'>#血管内治疗#</a>前经静脉使用<a href='/topic/show?id=ae20603536e' target=_blank style='color:#2F92EE;'>#替罗非班#</a>并不显著改善<a href='/topic/show?id=69df4400040' target=_blank style='color:#2F92EE;'>#大血管闭塞性卒中#</a>患者的临床结局。其实替罗非班这一类药物本早应该就淘汰了,无论从机制,还是哪种说法,没有太大的作用。, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89534, encryptionId=432089534a8, topicName=血管内治疗), TopicDto(id=60353, encryptionId=ae20603536e, topicName=替罗非班), TopicDto(id=44000, encryptionId=69df4400040, topicName=大血管闭塞性卒中)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=循证小兵, createdTime=Mon Aug 29 02:48:52 CST 2022, time=2022-08-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1698414, encodeId=448816984149c, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Thu Mar 16 20:17:11 CST 2023, time=2023-03-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1243644, encodeId=d333124364439, content=JAMA上文章都是顶级的,谢谢梅斯及时上新, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=肿瘤克星, createdTime=Wed Aug 10 05:17:11 CST 2022, time=2022-08-10, status=1, ipAttribution=)]
    2023-04-16 kkunny
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    2022-08-29 循证小兵

    #血管内治疗#前经静脉使用#替罗非班#并不显著改善#大血管闭塞性卒中#患者的临床结局。其实替罗非班这一类药物本早应该就淘汰了,无论从机制,还是哪种说法,没有太大的作用。

    0

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    2023-03-16 fusion
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    2022-08-10 肿瘤克星

    JAMA上文章都是顶级的,谢谢梅斯及时上新

    0

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