AJRCCM:肺动脉高压初始治疗策略与长期生存的关系

2021-10-01 刘少飞 MedSci原创

肺动脉高压 (PAH) 的初始治疗策略与生存率之间的关系仍不确定。

众所周知,在确认肺动脉高压 (PAH) 诊断后,2015 年欧洲心脏病学会 (ESC) / 欧洲呼吸学会 (ERS) 联合发布的肺动脉高压 (PH) 诊断和治疗指南和最近的世界肺动脉高压研讨会会议记录建议根据不良结果的风险水平定制初始治疗策略。

对于具有高死亡风险(一年内估计 > 10%)的最严重患者,建议初始联合治疗包括静脉注射 (IV) 前列环素。然而,该建议的证据水平较弱。 BREATHE-2 随机对照试验 (RCT) 未能证明接受静脉内 (IV) 依前列醇和波生坦双重联合治疗的患者与接受依前列醇单药治疗的患者之间的总肺阻力 (TPR) 变化存在显着差异。

然而,有一个数字趋势有利于联合治疗,并且在几个中心继续采用依前列醇和波生坦的初始联合治疗。在法国 PH 转诊中心对 23 名采用该策略启动的 PAH 患者进行的回顾性分析显示,纽约心脏协会 (NYHA) 功能等级 (FC)、运动能力和血流动力学得到长期改善。随后,在两项观察性研究中评估了初始三联疗法的效果,包括胃肠外前列环素、内皮素受体拮抗剂 (ERA) 和 5 型磷酸二酯酶抑制剂 (PDE-5i)。据报道,在使用依前列醇、波生坦和西地那非进行初始治疗 4 个月后,患有特发性或遗传性 PAH 的严重事件患者的 NYHA FC、运动能力和血流动力学有显着改善。最近在接受皮下曲前列环素、安立生坦和他达拉非初始联合治疗的 PAH 患者中报道了类似的结果。

对于诊断时处于低风险或中等风险的患者,推荐单药治疗或双口服联合治疗。 AMBITION RCT 证明了两种口服药物(安立生坦和他达拉非)的初始组合优于单一疗法(安立生坦或他达拉非),临床失败事件的主要终点时间缩短了 50%。值得注意的是,初始口服联合治疗和单药治疗之间的死亡率没有差异。没有研究评估初始治疗策略对 PAH 长期生存率的影响。我们回顾性研究的目的是根据初始治疗策略:单药治疗、双联疗法或三联疗法,评估大量特发性、遗传性或厌食素诱导的 PAH 患者的长期总体生存率和无移植生存率。这项研究的一些结果之前在欧洲呼吸学会大会和美国胸科学会年会上以摘要的形式报告过。

所以,研究的目的:
肺动脉高压 (PAH) 的初始治疗策略与生存率之间的关系仍不确定。根据初始治疗策略评估 PAH 的长期生存率

研究方法:

对在法国登记处登记的特发性、遗传性或厌食素诱导的 PAH 事件患者的回顾性分析(01/2006 至 12/2018)。根据初始策略评估存活率:单一疗法、双重或三重组合(两种口服药物和一种胃肠外前列环素)
研究结果:

在纳入的 1611 名患者中,984 名开始接受单药治疗,551 名接受双重治疗,76 名接受三联治疗。三联疗法组较年轻,合并症较少,但死亡风险较高。与双重或单药治疗(5 年均为 61%)相比,三联疗法(5 年 91%)的生存率更高,p<0.001。匹配年龄、性别和肺血管阻力的倾向评分也显示三联疗法和双重疗法之间存在显着差异(10 年生存率 85% 对 65%)。在高危患者 (n=243) 中,三联疗法与单药或双药治疗相比,生存率更高,而单药治疗和双药治疗之间没有差异。在中危患者 (n=1134) 中,生存率随着治疗次数的增加而提高。在多变量 Cox 回归中,三联疗法与较低的死亡风险独立相关(风险比 0.29,95% 置信区间 0.11-0.80,p=0.017)。在开始接受肠外前列环素治疗的 148 名患者中,三联疗法患者的生存率高于单药疗法或双药疗法的患者。
研究结论:

括胃肠外前列环素在内的初始三联疗法似乎与 PAH 的更好生存相关,尤其是在最年轻的高危患者中

 

研究出处:Boucly A. Association Between Initial Treatment Strategy and Long-term Survival in Pulmonary Arterial Hypertension. Am J Respir Crit Care Med. 2021 Jun 29. doi: 10.1164/rccm.202009-3698OC. Epub ahead of print. PMID: 34185620.

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    2022-01-31 isabellayj
  3. 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createdBy=d784426, createdName=isabellayj, createdTime=Mon Jan 31 02:26:04 CST 2022, time=2022-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1925388, encodeId=d2c81925388ac, content=<a href='/topic/show?id=26d633354c9' target=_blank style='color:#2F92EE;'>#动脉高压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33354, encryptionId=26d633354c9, topicName=动脉高压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Tue Aug 16 20:26:04 CST 2022, time=2022-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1057434, encodeId=5836105e43420, content=<a href='/topic/show?id=95dd820437d' target=_blank style='color:#2F92EE;'>#肺动脉#</a>包括胃肠外前列环素在内的初始三联疗法似乎与 PAH 的更好生存相关,尤其是在最年轻的高危患者中, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, 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createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 10:11:45 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1057432, encodeId=9e00105e432a7, content=<a href='/topic/show?id=0bad820e112' target=_blank style='color:#2F92EE;'>#肺动脉高压#</a>包括胃肠外前列环素在内的初始三联疗法似乎与 PAH 的更好生存相关,尤其是在最年轻的高危患者中, beContent=null, objectType=article, channel=null, level=null, likeNumber=137, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82071, encryptionId=0bad820e112, topicName=肺动脉高压)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 10:11:28 CST 2021, 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的更好生存相关,尤其是在最年轻的高危患者中, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82393, encryptionId=51b9823934e, topicName=肺高压症)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 10:11:03 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1618337, encodeId=09d3161833e75, content=<a href='/topic/show?id=3ebc9e0210b' target=_blank style='color:#2F92EE;'>#长期生存#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97021, encryptionId=3ebc9e0210b, topicName=长期生存)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e1f719885829, createdName=luckyshitiancai_42705690, createdTime=Sat Oct 02 16:26:04 CST 2021, time=2021-10-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1056796, encodeId=d9a11056e969a, content=不错学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210606/e8b96fdba070433da10cd357c0646807/28bf16f46e314caaad8396c0c7df7a04.jpg, createdBy=adb15496357, createdName=仁术2021, createdTime=Fri Oct 01 15:57:16 CST 2021, time=2021-10-01, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=2022125, encodeId=ed0c202212509, content=<a href='/topic/show?id=0ca732196ef' target=_blank style='color:#2F92EE;'>#初始治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32196, encryptionId=0ca732196ef, topicName=初始治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f7482500171, createdName=ms4468361851264128, createdTime=Sun Dec 19 05:26:04 CST 2021, time=2021-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2036696, encodeId=9581203669682, content=<a href='/topic/show?id=3bde1518863' target=_blank style='color:#2F92EE;'>#RCC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15188, encryptionId=3bde1518863, topicName=RCC)], attachment=null, authenticateStatus=null, createdAvatar=, 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topicId=null, topicList=[TopicDto(id=82043, encryptionId=95dd820437d, topicName=肺动脉)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 10:11:56 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1057433, encodeId=8d37105e433f7, content=<a href='/topic/show?id=b465820482a' target=_blank style='color:#2F92EE;'>#肺动脉发病机制#</a>包括胃肠外前列环素在内的初始三联疗法似乎与 PAH 的更好生存相关,尤其是在最年轻的高危患者中, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82048, encryptionId=b465820482a, topicName=肺动脉发病机制)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 10:11:45 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1057432, encodeId=9e00105e432a7, content=<a href='/topic/show?id=0bad820e112' target=_blank style='color:#2F92EE;'>#肺动脉高压#</a>包括胃肠外前列环素在内的初始三联疗法似乎与 PAH 的更好生存相关,尤其是在最年轻的高危患者中, beContent=null, objectType=article, channel=null, level=null, likeNumber=137, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82071, encryptionId=0bad820e112, topicName=肺动脉高压)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 10:11:28 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1057431, encodeId=5971105e43102, content=<a href='/topic/show?id=51b9823934e' target=_blank style='color:#2F92EE;'>#肺高压症#</a>包括胃肠外前列环素在内的初始三联疗法似乎与 PAH 的更好生存相关,尤其是在最年轻的高危患者中, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82393, encryptionId=51b9823934e, topicName=肺高压症)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 10:11:14 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1057430, encodeId=0066105e4304d, content=<a href='/topic/show?id=51b9823934e' target=_blank style='color:#2F92EE;'>#肺高压症#</a>包括胃肠外前列环素在内的初始三联疗法似乎与 PAH 的更好生存相关,尤其是在最年轻的高危患者中, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82393, encryptionId=51b9823934e, topicName=肺高压症)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 10:11:03 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1618337, encodeId=09d3161833e75, content=<a href='/topic/show?id=3ebc9e0210b' target=_blank style='color:#2F92EE;'>#长期生存#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97021, encryptionId=3ebc9e0210b, topicName=长期生存)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e1f719885829, createdName=luckyshitiancai_42705690, createdTime=Sat Oct 02 16:26:04 CST 2021, time=2021-10-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1056796, encodeId=d9a11056e969a, content=不错学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210606/e8b96fdba070433da10cd357c0646807/28bf16f46e314caaad8396c0c7df7a04.jpg, createdBy=adb15496357, createdName=仁术2021, createdTime=Fri Oct 01 15:57:16 CST 2021, time=2021-10-01, status=1, ipAttribution=)]
    2021-10-04 1def6e10m76(暂无匿称)

    #肺动脉#包括胃肠外前列环素在内的初始三联疗法似乎与 PAH 的更好生存相关,尤其是在最年轻的高危患者中

    0

  5. 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createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 10:11:45 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1057432, encodeId=9e00105e432a7, content=<a href='/topic/show?id=0bad820e112' target=_blank style='color:#2F92EE;'>#肺动脉高压#</a>包括胃肠外前列环素在内的初始三联疗法似乎与 PAH 的更好生存相关,尤其是在最年轻的高危患者中, beContent=null, objectType=article, channel=null, level=null, likeNumber=137, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82071, encryptionId=0bad820e112, topicName=肺动脉高压)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 10:11:28 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1057431, encodeId=5971105e43102, content=<a href='/topic/show?id=51b9823934e' target=_blank style='color:#2F92EE;'>#肺高压症#</a>包括胃肠外前列环素在内的初始三联疗法似乎与 PAH 的更好生存相关,尤其是在最年轻的高危患者中, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82393, encryptionId=51b9823934e, topicName=肺高压症)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 10:11:14 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1057430, encodeId=0066105e4304d, content=<a href='/topic/show?id=51b9823934e' target=_blank style='color:#2F92EE;'>#肺高压症#</a>包括胃肠外前列环素在内的初始三联疗法似乎与 PAH 的更好生存相关,尤其是在最年轻的高危患者中, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82393, encryptionId=51b9823934e, topicName=肺高压症)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 10:11:03 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1618337, encodeId=09d3161833e75, content=<a href='/topic/show?id=3ebc9e0210b' target=_blank style='color:#2F92EE;'>#长期生存#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97021, encryptionId=3ebc9e0210b, topicName=长期生存)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e1f719885829, createdName=luckyshitiancai_42705690, createdTime=Sat Oct 02 16:26:04 CST 2021, time=2021-10-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1056796, encodeId=d9a11056e969a, content=不错学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210606/e8b96fdba070433da10cd357c0646807/28bf16f46e314caaad8396c0c7df7a04.jpg, createdBy=adb15496357, createdName=仁术2021, createdTime=Fri Oct 01 15:57:16 CST 2021, time=2021-10-01, status=1, ipAttribution=)]
    2021-10-04 1def6e10m76(暂无匿称)

    #肺动脉发病机制#包括胃肠外前列环素在内的初始三联疗法似乎与 PAH 的更好生存相关,尤其是在最年轻的高危患者中

    0

  6. 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createdBy=d784426, createdName=isabellayj, createdTime=Mon Jan 31 02:26:04 CST 2022, time=2022-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1925388, encodeId=d2c81925388ac, content=<a href='/topic/show?id=26d633354c9' target=_blank style='color:#2F92EE;'>#动脉高压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33354, encryptionId=26d633354c9, topicName=动脉高压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Tue Aug 16 20:26:04 CST 2022, time=2022-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1057434, encodeId=5836105e43420, content=<a href='/topic/show?id=95dd820437d' target=_blank style='color:#2F92EE;'>#肺动脉#</a>包括胃肠外前列环素在内的初始三联疗法似乎与 PAH 的更好生存相关,尤其是在最年轻的高危患者中, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82043, encryptionId=95dd820437d, topicName=肺动脉)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 10:11:56 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1057433, encodeId=8d37105e433f7, content=<a href='/topic/show?id=b465820482a' target=_blank style='color:#2F92EE;'>#肺动脉发病机制#</a>包括胃肠外前列环素在内的初始三联疗法似乎与 PAH 的更好生存相关,尤其是在最年轻的高危患者中, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82048, encryptionId=b465820482a, topicName=肺动脉发病机制)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 10:11:45 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1057432, encodeId=9e00105e432a7, content=<a href='/topic/show?id=0bad820e112' target=_blank style='color:#2F92EE;'>#肺动脉高压#</a>包括胃肠外前列环素在内的初始三联疗法似乎与 PAH 的更好生存相关,尤其是在最年轻的高危患者中, beContent=null, objectType=article, channel=null, level=null, likeNumber=137, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82071, encryptionId=0bad820e112, topicName=肺动脉高压)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 10:11:28 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1057431, encodeId=5971105e43102, content=<a href='/topic/show?id=51b9823934e' target=_blank style='color:#2F92EE;'>#肺高压症#</a>包括胃肠外前列环素在内的初始三联疗法似乎与 PAH 的更好生存相关,尤其是在最年轻的高危患者中, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82393, encryptionId=51b9823934e, topicName=肺高压症)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 10:11:14 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1057430, encodeId=0066105e4304d, content=<a href='/topic/show?id=51b9823934e' target=_blank style='color:#2F92EE;'>#肺高压症#</a>包括胃肠外前列环素在内的初始三联疗法似乎与 PAH 的更好生存相关,尤其是在最年轻的高危患者中, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82393, encryptionId=51b9823934e, topicName=肺高压症)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 10:11:03 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1618337, encodeId=09d3161833e75, content=<a href='/topic/show?id=3ebc9e0210b' target=_blank style='color:#2F92EE;'>#长期生存#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97021, encryptionId=3ebc9e0210b, topicName=长期生存)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e1f719885829, createdName=luckyshitiancai_42705690, createdTime=Sat Oct 02 16:26:04 CST 2021, time=2021-10-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1056796, encodeId=d9a11056e969a, content=不错学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210606/e8b96fdba070433da10cd357c0646807/28bf16f46e314caaad8396c0c7df7a04.jpg, createdBy=adb15496357, createdName=仁术2021, createdTime=Fri Oct 01 15:57:16 CST 2021, time=2021-10-01, status=1, ipAttribution=)]
    2021-10-04 1def6e10m76(暂无匿称)

    #肺动脉高压#包括胃肠外前列环素在内的初始三联疗法似乎与 PAH 的更好生存相关,尤其是在最年轻的高危患者中

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=2022125, encodeId=ed0c202212509, content=<a href='/topic/show?id=0ca732196ef' target=_blank style='color:#2F92EE;'>#初始治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32196, encryptionId=0ca732196ef, topicName=初始治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f7482500171, createdName=ms4468361851264128, createdTime=Sun Dec 19 05:26:04 CST 2021, time=2021-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2036696, encodeId=9581203669682, content=<a href='/topic/show?id=3bde1518863' target=_blank style='color:#2F92EE;'>#RCC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15188, encryptionId=3bde1518863, topicName=RCC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d784426, createdName=isabellayj, createdTime=Mon Jan 31 02:26:04 CST 2022, time=2022-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1925388, encodeId=d2c81925388ac, content=<a href='/topic/show?id=26d633354c9' target=_blank style='color:#2F92EE;'>#动脉高压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33354, encryptionId=26d633354c9, topicName=动脉高压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Tue Aug 16 20:26:04 CST 2022, time=2022-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1057434, encodeId=5836105e43420, content=<a href='/topic/show?id=95dd820437d' target=_blank style='color:#2F92EE;'>#肺动脉#</a>包括胃肠外前列环素在内的初始三联疗法似乎与 PAH 的更好生存相关,尤其是在最年轻的高危患者中, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82043, encryptionId=95dd820437d, topicName=肺动脉)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 10:11:56 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1057433, encodeId=8d37105e433f7, content=<a href='/topic/show?id=b465820482a' target=_blank style='color:#2F92EE;'>#肺动脉发病机制#</a>包括胃肠外前列环素在内的初始三联疗法似乎与 PAH 的更好生存相关,尤其是在最年轻的高危患者中, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82048, encryptionId=b465820482a, topicName=肺动脉发病机制)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 10:11:45 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1057432, encodeId=9e00105e432a7, content=<a href='/topic/show?id=0bad820e112' target=_blank style='color:#2F92EE;'>#肺动脉高压#</a>包括胃肠外前列环素在内的初始三联疗法似乎与 PAH 的更好生存相关,尤其是在最年轻的高危患者中, beContent=null, objectType=article, channel=null, level=null, likeNumber=137, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82071, encryptionId=0bad820e112, topicName=肺动脉高压)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 10:11:28 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1057431, encodeId=5971105e43102, content=<a href='/topic/show?id=51b9823934e' target=_blank style='color:#2F92EE;'>#肺高压症#</a>包括胃肠外前列环素在内的初始三联疗法似乎与 PAH 的更好生存相关,尤其是在最年轻的高危患者中, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82393, encryptionId=51b9823934e, topicName=肺高压症)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 10:11:14 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1057430, encodeId=0066105e4304d, content=<a href='/topic/show?id=51b9823934e' target=_blank style='color:#2F92EE;'>#肺高压症#</a>包括胃肠外前列环素在内的初始三联疗法似乎与 PAH 的更好生存相关,尤其是在最年轻的高危患者中, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82393, encryptionId=51b9823934e, topicName=肺高压症)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 10:11:03 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1618337, encodeId=09d3161833e75, content=<a href='/topic/show?id=3ebc9e0210b' target=_blank style='color:#2F92EE;'>#长期生存#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97021, encryptionId=3ebc9e0210b, topicName=长期生存)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e1f719885829, createdName=luckyshitiancai_42705690, createdTime=Sat Oct 02 16:26:04 CST 2021, time=2021-10-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1056796, encodeId=d9a11056e969a, content=不错学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210606/e8b96fdba070433da10cd357c0646807/28bf16f46e314caaad8396c0c7df7a04.jpg, createdBy=adb15496357, createdName=仁术2021, createdTime=Fri Oct 01 15:57:16 CST 2021, time=2021-10-01, status=1, ipAttribution=)]
    2021-10-04 1def6e10m76(暂无匿称)

    #肺高压症#包括胃肠外前列环素在内的初始三联疗法似乎与 PAH 的更好生存相关,尤其是在最年轻的高危患者中

    0

  8. 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createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 10:11:45 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1057432, encodeId=9e00105e432a7, content=<a href='/topic/show?id=0bad820e112' target=_blank style='color:#2F92EE;'>#肺动脉高压#</a>包括胃肠外前列环素在内的初始三联疗法似乎与 PAH 的更好生存相关,尤其是在最年轻的高危患者中, beContent=null, objectType=article, channel=null, level=null, likeNumber=137, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82071, encryptionId=0bad820e112, topicName=肺动脉高压)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 10:11:28 CST 2021, 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的更好生存相关,尤其是在最年轻的高危患者中, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82393, encryptionId=51b9823934e, topicName=肺高压症)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 10:11:03 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1618337, encodeId=09d3161833e75, content=<a href='/topic/show?id=3ebc9e0210b' target=_blank style='color:#2F92EE;'>#长期生存#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97021, encryptionId=3ebc9e0210b, topicName=长期生存)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e1f719885829, createdName=luckyshitiancai_42705690, createdTime=Sat Oct 02 16:26:04 CST 2021, time=2021-10-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1056796, encodeId=d9a11056e969a, content=不错学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210606/e8b96fdba070433da10cd357c0646807/28bf16f46e314caaad8396c0c7df7a04.jpg, createdBy=adb15496357, createdName=仁术2021, createdTime=Fri Oct 01 15:57:16 CST 2021, time=2021-10-01, status=1, ipAttribution=)]
    2021-10-04 1def6e10m76(暂无匿称)

    #肺高压症#包括胃肠外前列环素在内的初始三联疗法似乎与 PAH 的更好生存相关,尤其是在最年轻的高危患者中

    0

  9. 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createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 10:11:45 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1057432, encodeId=9e00105e432a7, content=<a href='/topic/show?id=0bad820e112' target=_blank style='color:#2F92EE;'>#肺动脉高压#</a>包括胃肠外前列环素在内的初始三联疗法似乎与 PAH 的更好生存相关,尤其是在最年轻的高危患者中, beContent=null, objectType=article, channel=null, level=null, likeNumber=137, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82071, encryptionId=0bad820e112, topicName=肺动脉高压)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 10:11:28 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1057431, encodeId=5971105e43102, content=<a href='/topic/show?id=51b9823934e' target=_blank style='color:#2F92EE;'>#肺高压症#</a>包括胃肠外前列环素在内的初始三联疗法似乎与 PAH 的更好生存相关,尤其是在最年轻的高危患者中, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82393, encryptionId=51b9823934e, topicName=肺高压症)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 10:11:14 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1057430, encodeId=0066105e4304d, content=<a href='/topic/show?id=51b9823934e' target=_blank style='color:#2F92EE;'>#肺高压症#</a>包括胃肠外前列环素在内的初始三联疗法似乎与 PAH 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  10. 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    2021-10-01 仁术2021

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