GW-ICC 2016:郭艺芳谈心衰合并COPD,β受体阻滞剂使用率低

2016-10-21 郭艺芳 长城国际心脏病学会议

β受体阻滞剂是慢性心衰药物治疗的基石,长期充分地应用β受体阻滞剂治疗可显著降低慢性心衰患者的心血管事件风险、再住院率以及死亡率。然而,近日发表在《Heart》杂志上的一项研究结果却表明,大量的心衰合并慢性阻塞性肺病(COPD)患者并未接受β受体阻滞剂治疗。研究共纳入89861例 COPD患者、24237例心衰患者和10853例心衰合并COPD患者。心衰合并COPD患者的平均年龄为79 岁,其中

β受体阻滞剂是慢性心衰药物治疗的基石,长期充分地应用β受体阻滞剂治疗可显著降低慢性心衰患者的心血管事件风险、再住院率以及死亡率。然而,近日发表在《Heart》杂志上的一项研究结果却表明,大量的心衰合并慢性阻塞性肺病(COPD)患者并未接受β受体阻滞剂治疗。


研究共纳入89861例 COPD患者、24237例心衰患者和10853例心衰合并COPD患者。心衰合并COPD患者的平均年龄为79 岁,其中60%为男性,27%既往心肌梗死。在心衰合并COPD的患者中,同时服用β受体阻滞剂和ACEI或ARB的比例为22%;在仅有心衰的患者中,该比例达到41%(校正后OR 0.54,95%CI 0.51~0.58,P<0.001)。联用吸入性糖皮质激素(ICS)、长效β受体激动剂(LABA)和长效M受体阻滞剂的心衰合并COPD患者中,同时服用ACEI/ARB和β受体阻滞剂的比例为27%;在不服用β受体阻滞剂的情况下,服用ACEI/ARB的比例达到46%(1316例)。



​图1. 吸入疗法时,使用β受体阻滞剂的情况。深色表示患者服用ACEI/ARB,不服用β受体阻滞剂;浅色表示患者同时服用ACEI/ARB和β受体阻滞剂


河北省人民医院郭艺芳教授对此评论道,对于合并COPD的心衰患者,因为过度担心β受体阻滞剂对于气管-支气管的不良作用,很多医生与患者会拒绝应用此类药物治疗。该研究结果正反映了这一现象。


然而,已有大量研究结果表明,对于合并COPD的慢性心衰患者,应用β受体阻滞剂治疗同样可以显著降低心血管事件风险,并改善其远期预后,并且这些研究结果与治疗理念已在相关指南性文件中得以体现。简单地讲,除合并支气管痉挛的患者外,多数情况下,COPD并非应用选择性β1受体阻滞剂治疗的禁忌证。当然,COPD患者可能对于β受体阻滞剂的治疗更为敏感。与无呼吸道疾病的患者相比,此类患者应用β受体阻滞剂治疗时,要更为密切地监测呼吸道的症状与体征,以及心率和血压,以更小的剂量启动治疗,并根据治疗反应,缓慢增加到患者所能耐受的最大剂量或指南所推荐的目标剂量。


对于我国慢性心衰合并COPD患者应用β受体阻滞剂的治疗现状,郭艺芳教授指出,我国尚缺乏大规模的调查。不过,一些小型回顾性研究结果表明,我国情况也不容乐观。不仅如此,很多没有明确适应证的患者却接受了β受体激动剂的治疗。对于合并慢性心衰与缺血性心脏病的患者,β受体激动剂可以显著增加不良心血管事件风险。总之,在今后临床工作中应该更加重视这一问题,努力减少β受体激动剂的应用,提高β受体阻滞剂的治疗率。


延伸阅读

心衰合并COPD患者的临床特征、运动训练反应和预后


2013年,《美国心脏杂志》(Am Heart J)杂志发表的一项研究显示,心衰患者合并COPD与高龄、合并症多、运动耐量减低、心血管死亡率/心衰住院率增加有关。不管患者是否合并COPD,β受体阻滞剂的选择性与预后无关。


该研究结果显示,在有COPD状态的2311例患者中,11%(249例)确有COPD。COPD患者的年龄更大、合并症更多、使用β受体阻滞剂更少。在基线水平,COPD患者耗氧量峰值较低,Ve/Vco2斜率较高。中位随访2.5年,COPD与死亡率/住院率、死亡率、心血管死亡率/心衰住院率增加相关。多变量校正后,心血管死亡/心衰住院风险仍增加(HR 1.46,95%CI 1.14~1.87),但死亡率/住院率(HR 1.15,95% CI 0.96-1.37)、死亡率(HR 1.33,95% CI 0.99-1.76)无显著增加。


该研究是对HF-ACTION试验数据进行的分析。HF-ACTION试验共入选2331例接受或未接受有氧训练的心衰患者(射血分数≤35%)。通过Cox模型分析了临床特征与预后(死亡率/住院率、死亡率、心血管死亡率/心血管住院率、心血管死亡率/心衰住院率),以及与运动训练的关系。同时还分析了β受体阻滞剂的心脏选择性与预后的关系。


参考资料:


[1] Underuse of β-blockers in heart failure and chronic obstructive pulmonary disease. Lipworth B, et al. Heart 2016;0:1-6. doi:10.1136/heartjnl-2016-309458.

[2] Clinical Characteristics, Response to Exercise Training and Outcomes in Heart Failure Patients with Chronic Obstructive Pulmonary Disease: Findings from HF-ACTION. Mentz et al. Am Heart J. 2013 February ; 165(2): 193-199. doi:10.1016/j.ahj.2012.10.029.


专家简介

郭艺芳教授,现任河北省人民医院副院长、老年心脏科主任;兼任中国医师协会心血管内科医师分会常委、中国高血压联盟理事、河北省医学会老年医学分会主任委员,《中华高血压杂志》、《中国心血管杂志》常务编委。

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encryptionId=32fd933505, topicName=ICC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=36506466438, createdName=zhs3884, createdTime=Sun Oct 23 07:03:00 CST 2016, time=2016-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1527180, encodeId=0694152e18013, content=<a href='/topic/show?id=81ca834123' target=_blank style='color:#2F92EE;'>#GW-ICC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8341, encryptionId=81ca834123, topicName=GW-ICC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=00e511815854, createdName=chenwq12, createdTime=Sun Oct 23 07:03:00 CST 2016, time=2016-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615901, encodeId=88811615901c4, content=<a href='/topic/show?id=158826812c4' target=_blank style='color:#2F92EE;'>#使用率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26812, encryptionId=158826812c4, topicName=使用率)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8dee19693687, createdName=ms3830150583600765, createdTime=Sun Oct 23 07:03:00 CST 2016, time=2016-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=150302, encodeId=8ad615030293, content=做得非常不错!涨姿势了, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=445f1740270, createdName=meiliwuxian, createdTime=Sat Oct 22 11:09:16 CST 2016, time=2016-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=150187, encodeId=c14115018eac, content=学习到了很多,受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160717/IMG578BA7C21F5227685.jpg, createdBy=70421925809, createdName=1e0ba702m86(暂无匿称), createdTime=Fri Oct 21 20:47:15 CST 2016, time=2016-10-21, status=1, ipAttribution=)]
    2016-11-10 1e0d99ddm02(暂无匿称)

    了解一下!

    0

  4. 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createdName=zhaojie88, createdTime=Tue Jul 25 14:03:00 CST 2017, time=2017-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=154870, encodeId=e00a1548e012, content=了解一下!, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Thu Nov 10 20:43:52 CST 2016, time=2016-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=150490, encodeId=74b7150490cd, content=谢谢分享,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Sun Oct 23 07:17:08 CST 2016, time=2016-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1274944, encodeId=11ba12e49441d, content=<a href='/topic/show?id=338c19228b0' target=_blank style='color:#2F92EE;'>#β受体阻滞剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=19228, encryptionId=338c19228b0, topicName=β受体阻滞剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=685a124, createdName=muzishouyi, createdTime=Sun Oct 23 07:03:00 CST 2016, time=2016-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1462019, encodeId=b49714620195d, content=<a href='/topic/show?id=32fd933505' target=_blank style='color:#2F92EE;'>#ICC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9335, encryptionId=32fd933505, topicName=ICC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=36506466438, createdName=zhs3884, createdTime=Sun Oct 23 07:03:00 CST 2016, time=2016-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1527180, encodeId=0694152e18013, content=<a href='/topic/show?id=81ca834123' target=_blank style='color:#2F92EE;'>#GW-ICC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8341, encryptionId=81ca834123, topicName=GW-ICC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=00e511815854, createdName=chenwq12, createdTime=Sun Oct 23 07:03:00 CST 2016, time=2016-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615901, encodeId=88811615901c4, content=<a href='/topic/show?id=158826812c4' target=_blank style='color:#2F92EE;'>#使用率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26812, encryptionId=158826812c4, topicName=使用率)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8dee19693687, createdName=ms3830150583600765, createdTime=Sun Oct 23 07:03:00 CST 2016, time=2016-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=150302, encodeId=8ad615030293, content=做得非常不错!涨姿势了, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=445f1740270, createdName=meiliwuxian, createdTime=Sat Oct 22 11:09:16 CST 2016, time=2016-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=150187, encodeId=c14115018eac, content=学习到了很多,受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160717/IMG578BA7C21F5227685.jpg, createdBy=70421925809, createdName=1e0ba702m86(暂无匿称), createdTime=Fri Oct 21 20:47:15 CST 2016, time=2016-10-21, status=1, ipAttribution=)]
    2016-10-23 刘煜

    谢谢分享,学习了。

    0

  5. 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encryptionId=32fd933505, topicName=ICC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=36506466438, createdName=zhs3884, createdTime=Sun Oct 23 07:03:00 CST 2016, time=2016-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1527180, encodeId=0694152e18013, content=<a href='/topic/show?id=81ca834123' target=_blank style='color:#2F92EE;'>#GW-ICC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8341, encryptionId=81ca834123, topicName=GW-ICC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=00e511815854, createdName=chenwq12, createdTime=Sun Oct 23 07:03:00 CST 2016, time=2016-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615901, encodeId=88811615901c4, content=<a href='/topic/show?id=158826812c4' target=_blank style='color:#2F92EE;'>#使用率#</a>, beContent=null, objectType=article, 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topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160717/IMG578BA7C21F5227685.jpg, createdBy=70421925809, createdName=1e0ba702m86(暂无匿称), createdTime=Fri Oct 21 20:47:15 CST 2016, time=2016-10-21, status=1, ipAttribution=)]
  6. 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channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26812, encryptionId=158826812c4, topicName=使用率)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8dee19693687, createdName=ms3830150583600765, createdTime=Sun Oct 23 07:03:00 CST 2016, time=2016-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=150302, encodeId=8ad615030293, content=做得非常不错!涨姿势了, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=445f1740270, createdName=meiliwuxian, createdTime=Sat Oct 22 11:09:16 CST 2016, time=2016-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=150187, encodeId=c14115018eac, content=学习到了很多,受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160717/IMG578BA7C21F5227685.jpg, createdBy=70421925809, createdName=1e0ba702m86(暂无匿称), createdTime=Fri Oct 21 20:47:15 CST 2016, time=2016-10-21, status=1, ipAttribution=)]
    2016-10-23 zhs3884
  7. 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createdName=zhaojie88, createdTime=Tue Jul 25 14:03:00 CST 2017, time=2017-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=154870, encodeId=e00a1548e012, content=了解一下!, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Thu Nov 10 20:43:52 CST 2016, time=2016-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=150490, encodeId=74b7150490cd, content=谢谢分享,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Sun Oct 23 07:17:08 CST 2016, time=2016-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1274944, encodeId=11ba12e49441d, content=<a href='/topic/show?id=338c19228b0' target=_blank style='color:#2F92EE;'>#β受体阻滞剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=19228, encryptionId=338c19228b0, topicName=β受体阻滞剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=685a124, createdName=muzishouyi, createdTime=Sun Oct 23 07:03:00 CST 2016, time=2016-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1462019, encodeId=b49714620195d, content=<a href='/topic/show?id=32fd933505' target=_blank style='color:#2F92EE;'>#ICC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9335, encryptionId=32fd933505, topicName=ICC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=36506466438, createdName=zhs3884, createdTime=Sun Oct 23 07:03:00 CST 2016, time=2016-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1527180, encodeId=0694152e18013, content=<a href='/topic/show?id=81ca834123' target=_blank style='color:#2F92EE;'>#GW-ICC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8341, encryptionId=81ca834123, topicName=GW-ICC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=00e511815854, createdName=chenwq12, createdTime=Sun Oct 23 07:03:00 CST 2016, time=2016-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615901, encodeId=88811615901c4, content=<a href='/topic/show?id=158826812c4' target=_blank style='color:#2F92EE;'>#使用率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26812, encryptionId=158826812c4, topicName=使用率)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8dee19693687, createdName=ms3830150583600765, createdTime=Sun Oct 23 07:03:00 CST 2016, time=2016-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=150302, encodeId=8ad615030293, content=做得非常不错!涨姿势了, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=445f1740270, createdName=meiliwuxian, createdTime=Sat Oct 22 11:09:16 CST 2016, time=2016-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=150187, encodeId=c14115018eac, content=学习到了很多,受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160717/IMG578BA7C21F5227685.jpg, createdBy=70421925809, createdName=1e0ba702m86(暂无匿称), createdTime=Fri Oct 21 20:47:15 CST 2016, time=2016-10-21, status=1, ipAttribution=)]
    2016-10-23 chenwq12
  8. [GetPortalCommentsPageByObjectIdResponse(id=2085737, encodeId=2a012085e370e, content=<a href='/topic/show?id=723a9e69383' target=_blank style='color:#2F92EE;'>#阻滞剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97693, encryptionId=723a9e69383, topicName=阻滞剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=40be178, createdName=zhyy88, createdTime=Thu Mar 02 04:03:00 CST 2017, time=2017-03-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1995135, encodeId=05461995135bf, content=<a href='/topic/show?id=347538040cf' target=_blank style='color:#2F92EE;'>#受体阻滞剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38040, encryptionId=347538040cf, topicName=受体阻滞剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Tue Jul 25 14:03:00 CST 2017, time=2017-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=154870, encodeId=e00a1548e012, content=了解一下!, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Thu Nov 10 20:43:52 CST 2016, time=2016-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=150490, encodeId=74b7150490cd, content=谢谢分享,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Sun Oct 23 07:17:08 CST 2016, time=2016-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1274944, encodeId=11ba12e49441d, content=<a href='/topic/show?id=338c19228b0' target=_blank style='color:#2F92EE;'>#β受体阻滞剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=19228, encryptionId=338c19228b0, topicName=β受体阻滞剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=685a124, createdName=muzishouyi, createdTime=Sun Oct 23 07:03:00 CST 2016, time=2016-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1462019, encodeId=b49714620195d, content=<a href='/topic/show?id=32fd933505' target=_blank style='color:#2F92EE;'>#ICC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9335, encryptionId=32fd933505, topicName=ICC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=36506466438, createdName=zhs3884, createdTime=Sun Oct 23 07:03:00 CST 2016, time=2016-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1527180, encodeId=0694152e18013, content=<a href='/topic/show?id=81ca834123' target=_blank style='color:#2F92EE;'>#GW-ICC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8341, encryptionId=81ca834123, topicName=GW-ICC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=00e511815854, createdName=chenwq12, createdTime=Sun Oct 23 07:03:00 CST 2016, time=2016-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615901, encodeId=88811615901c4, content=<a href='/topic/show?id=158826812c4' target=_blank style='color:#2F92EE;'>#使用率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26812, encryptionId=158826812c4, topicName=使用率)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8dee19693687, createdName=ms3830150583600765, createdTime=Sun Oct 23 07:03:00 CST 2016, time=2016-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=150302, encodeId=8ad615030293, content=做得非常不错!涨姿势了, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=445f1740270, createdName=meiliwuxian, createdTime=Sat Oct 22 11:09:16 CST 2016, time=2016-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=150187, encodeId=c14115018eac, content=学习到了很多,受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160717/IMG578BA7C21F5227685.jpg, createdBy=70421925809, createdName=1e0ba702m86(暂无匿称), createdTime=Fri Oct 21 20:47:15 CST 2016, time=2016-10-21, status=1, ipAttribution=)]
  9. [GetPortalCommentsPageByObjectIdResponse(id=2085737, encodeId=2a012085e370e, content=<a href='/topic/show?id=723a9e69383' target=_blank style='color:#2F92EE;'>#阻滞剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97693, encryptionId=723a9e69383, topicName=阻滞剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=40be178, createdName=zhyy88, createdTime=Thu Mar 02 04:03:00 CST 2017, time=2017-03-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1995135, encodeId=05461995135bf, content=<a href='/topic/show?id=347538040cf' target=_blank style='color:#2F92EE;'>#受体阻滞剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38040, encryptionId=347538040cf, topicName=受体阻滞剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Tue Jul 25 14:03:00 CST 2017, time=2017-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=154870, encodeId=e00a1548e012, content=了解一下!, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Thu Nov 10 20:43:52 CST 2016, time=2016-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=150490, encodeId=74b7150490cd, content=谢谢分享,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Sun Oct 23 07:17:08 CST 2016, time=2016-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1274944, encodeId=11ba12e49441d, content=<a href='/topic/show?id=338c19228b0' target=_blank style='color:#2F92EE;'>#β受体阻滞剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=19228, encryptionId=338c19228b0, topicName=β受体阻滞剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=685a124, createdName=muzishouyi, createdTime=Sun Oct 23 07:03:00 CST 2016, time=2016-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1462019, encodeId=b49714620195d, content=<a href='/topic/show?id=32fd933505' target=_blank style='color:#2F92EE;'>#ICC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9335, encryptionId=32fd933505, topicName=ICC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=36506466438, createdName=zhs3884, createdTime=Sun Oct 23 07:03:00 CST 2016, time=2016-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1527180, encodeId=0694152e18013, content=<a href='/topic/show?id=81ca834123' target=_blank style='color:#2F92EE;'>#GW-ICC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8341, encryptionId=81ca834123, topicName=GW-ICC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=00e511815854, createdName=chenwq12, createdTime=Sun Oct 23 07:03:00 CST 2016, time=2016-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615901, encodeId=88811615901c4, content=<a href='/topic/show?id=158826812c4' target=_blank style='color:#2F92EE;'>#使用率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26812, encryptionId=158826812c4, topicName=使用率)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8dee19693687, createdName=ms3830150583600765, createdTime=Sun Oct 23 07:03:00 CST 2016, time=2016-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=150302, encodeId=8ad615030293, content=做得非常不错!涨姿势了, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=445f1740270, createdName=meiliwuxian, createdTime=Sat Oct 22 11:09:16 CST 2016, time=2016-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=150187, encodeId=c14115018eac, content=学习到了很多,受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160717/IMG578BA7C21F5227685.jpg, createdBy=70421925809, createdName=1e0ba702m86(暂无匿称), createdTime=Fri Oct 21 20:47:15 CST 2016, time=2016-10-21, status=1, ipAttribution=)]
    2016-10-22 meiliwuxian

    做得非常不错!涨姿势了

    0

  10. [GetPortalCommentsPageByObjectIdResponse(id=2085737, encodeId=2a012085e370e, content=<a href='/topic/show?id=723a9e69383' target=_blank style='color:#2F92EE;'>#阻滞剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97693, encryptionId=723a9e69383, topicName=阻滞剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=40be178, createdName=zhyy88, createdTime=Thu Mar 02 04:03:00 CST 2017, time=2017-03-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1995135, encodeId=05461995135bf, content=<a href='/topic/show?id=347538040cf' target=_blank style='color:#2F92EE;'>#受体阻滞剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38040, encryptionId=347538040cf, topicName=受体阻滞剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Tue Jul 25 14:03:00 CST 2017, time=2017-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=154870, encodeId=e00a1548e012, content=了解一下!, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Thu Nov 10 20:43:52 CST 2016, time=2016-11-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=150490, encodeId=74b7150490cd, content=谢谢分享,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Sun Oct 23 07:17:08 CST 2016, time=2016-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1274944, encodeId=11ba12e49441d, content=<a href='/topic/show?id=338c19228b0' target=_blank style='color:#2F92EE;'>#β受体阻滞剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=19228, encryptionId=338c19228b0, topicName=β受体阻滞剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=685a124, createdName=muzishouyi, createdTime=Sun Oct 23 07:03:00 CST 2016, time=2016-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1462019, encodeId=b49714620195d, content=<a href='/topic/show?id=32fd933505' target=_blank style='color:#2F92EE;'>#ICC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9335, encryptionId=32fd933505, topicName=ICC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=36506466438, createdName=zhs3884, createdTime=Sun Oct 23 07:03:00 CST 2016, time=2016-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1527180, encodeId=0694152e18013, content=<a href='/topic/show?id=81ca834123' target=_blank style='color:#2F92EE;'>#GW-ICC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8341, encryptionId=81ca834123, topicName=GW-ICC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=00e511815854, createdName=chenwq12, createdTime=Sun Oct 23 07:03:00 CST 2016, time=2016-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615901, encodeId=88811615901c4, content=<a href='/topic/show?id=158826812c4' target=_blank style='color:#2F92EE;'>#使用率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26812, encryptionId=158826812c4, topicName=使用率)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8dee19693687, createdName=ms3830150583600765, createdTime=Sun Oct 23 07:03:00 CST 2016, time=2016-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=150302, encodeId=8ad615030293, content=做得非常不错!涨姿势了, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=445f1740270, createdName=meiliwuxian, createdTime=Sat Oct 22 11:09:16 CST 2016, time=2016-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=150187, encodeId=c14115018eac, content=学习到了很多,受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160717/IMG578BA7C21F5227685.jpg, createdBy=70421925809, createdName=1e0ba702m86(暂无匿称), createdTime=Fri Oct 21 20:47:15 CST 2016, time=2016-10-21, status=1, ipAttribution=)]
    2016-10-21 1e0ba702m86(暂无匿称)

    学习到了很多,受益匪浅

    0

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