经导管心脏瓣膜疾病介入治疗进展及中国发展现状

2015-04-03 王建安 刘先宝 中国医学前沿杂志

随着社会经济的发展和人口的老龄化,瓣膜性心脏病的发病率明显增加,研究表明>75岁的老年人群瓣膜性心脏病发病率高达13.3%。外科手术治疗仍是重度瓣膜病变患者的首选治疗手段,但对于高龄、合并多器官疾病 、有开胸手术史以及心功能较差的患者,Euro SCORE和(或)STS评分高,外科手术死亡率高,甚至部分患者失去了手术机会。近年来,经导管瓣膜置入/修复术逐渐

随着社会经济的发展和人口的老龄化,瓣膜性心脏病的发病率明显增加,研究表明>75岁的老年人群瓣膜性心脏病发病率高达13.3%。外科手术治疗仍是重度瓣膜病变患者的首选治疗手段,但对于高龄、合并多器官疾病 、有开胸手术史以及心功能较差的患者,Euro SCORE和(或)STS评分高,外科手术死亡率高,甚至部分患者失去了手术机会。近年来,经导管瓣膜置入/修复术逐渐成熟并广泛应用,尤其是经导管主动脉瓣置入(TAVI)和经导管二尖瓣夹合术(MitraClip)的循证学依据较为充分,得到了欧洲和美国心脏瓣膜疾病治疗指南的推荐,是心脏瓣膜疾病介入治疗领域里程碑式的进展。本文就经导管主动脉瓣和二尖瓣介入治疗进展作一阐述。

一、TAVI

1.循证学依据不断积累

自1992年Andersen等成功开展动物实验后,2002年Cribier等首次将TAVI应用于人体并取得了成功,此后TAVI技术快速发展,据不完全统计,全球约40个国家和地区开展此项技术,累计开展例数约15万例。应用的瓣膜类型主要为爱德华公司的EdwardsSapien和美敦力公司的CoreValve。

PARTNER系列研究是TAVI里程碑式的研究,应用Edwards Sapien瓣膜分别针对外科手术高危和禁忌的重度主动脉瓣狭窄患者进行研究,1~3年的随访结果均证实了TAVI的安全性和有效性。2014年经导管心血管治疗(TCT)年会公布了PARTNERIB(in-operable)5年随访结果,提示与标准治疗相比,TAVI在全因死亡率(71.8%:93.6%)、心血管死亡(57.3%:85.9%)、再次住院率(47.6%:87.3%)、心功能改善(III:IV=14.3%:40%)方面均有明显获益。

CoreValve US Pivotal Trial(High Risk)随机对照研究共纳入795例外科手术高危的重度主动脉瓣狭窄患者,随机行外科主动脉瓣置换术或经导管CoreValve置换术,随访1年结果表明TAVI组主要终点事件(任何原因死亡)显著少于外科手术组(14.2%:19.1%),主要不良心脑血管事件(MACCE)降低近7%(20.4%:27.3%),提示经导管CoreValve瓣膜置换术优于外科主动脉瓣置换术,进一步肯定了TAVI的地位。针对不适合手术的患者,CoreValve US Pivotal Trial(Extreme Risk)研究共纳入489例经股动脉途径的患者,研究发现1年的一级终点(全因死亡率或主要卒中事件)为26%,较类似研究对照组(43%)明显下降。2014年TCT年会公布了2年随访结果,全因死亡率或主要卒中事件为38%,较类似研究对照组(57.9%)显著下降,说明TAVI应用CoreValve治疗科手术禁忌患者是安全有效的。

许多注册研究(FRANCE2、source、GARY、ADVANCE等)结果显示:TAVI手术即刻成功率高达93.8%~98.4%,30天生存率为82.2%~92.9%,1年生存率为76.1%~84.2%,表明TAVI对重度症状性主动脉瓣狭窄患者是安全可行的。

2.适应证有进一步拓展的趋势

令人鼓舞的是,新的临床证据使TAVI的适应证有不断拓宽的趋势。

(1)重度主动脉瓣狭窄的中/低危患者

目前的指南推荐TAVI仅限于高/极高危人群,对于中/低危人群外科手术仍是首选方案。但是,欧洲部分中心已尝试对重度主动脉瓣狭窄的中/低危患者进行TAVI治疗的研究,有报道显示在更年轻、风险更低的患者中,TAVI有减少死亡和心血管事件的趋势。针对中危患者的随机对照研究PARTNERIIA(Edwards SAPIEN瓣膜)已经完成入组工作,SURTAVI(Medtronic CoreValve瓣膜)也正在开展当中,我们拭目以待。

(2)二叶式主动脉瓣

二叶式主动脉瓣畸形是最常见的先天性瓣膜疾病,在普通人群的发病率为1%~2%,由其所致的重度主动脉瓣狭窄一直被视为TAVI的相对禁忌证,目前尚缺乏充足的循证医学依据,患者的选择标准、置入瓣膜装置的耐久性及其对扩张的升主动脉的影响等问题仍有待进一步研究。一项德国注册研究提示,二叶式主动脉瓣术后瓣周漏发生率高于三叶式主动脉瓣(25%:15%,P=0.05),起搏器置入率则较低(17%:35%,P=0.02),30天和1年的死亡率无差别,反映了TAVI在二叶式主动脉瓣中应用的安全性和有效性。其他多项研究也证实了TAVI在二叶式主动脉瓣中应用的可行性。与国外人群不同的是,中国人群二叶式主动脉瓣的发生率非常高,TAVI人群中二叶式主动脉瓣畸形(包括功能性)约占50%。本中心对15例二叶式主动脉瓣(不包括功能性)和25例三叶式主动脉瓣患者的TAVI手术进行了比较,发现两组患者在手术成功率、30天死亡率以及瓣周漏、卒中、起搏器植入率等并发症方面无明显差异。因此,在严格选择二叶式主动脉瓣狭窄患者的前提下,谨慎开展TAVI是可行的。

(3)主动脉瓣关闭不全

目前也有研究发现对于有手术禁忌的重度单纯主动脉瓣反流患者,TAVI可获得可以接受的疗效。Roy等对14个中心43例重度单纯主动脉瓣反流患者进行研究,平均(75.3±8.8)岁,外科手术高危(Log EuroScore:26.9%±17.9%,STS:10.2%±5.3%),应用Medtronic CoreValve瓣膜,在双猪尾导管指导定位的基础上,瓣膜成功置入率达97.7%,30天和1年的全因死亡率分别为9.3%和21.4%,与主动脉瓣狭窄类似。但有18.6%的患者因瓣周漏明显而需要置入第2个瓣膜。本中心在国内率先尝试经股动脉途径对3例外科手术高危的无钙化单纯性主动脉瓣重度反流患者进行TAVI治疗,手术成功开展,术后患者恢复良好。因此,TAVI应用于重度单纯主动脉瓣反流的患者是可行的。

3.新型瓣膜不断呈现

虽然TAVI的安全性和有效性已得到认可并被广泛应用于临床,但是,瓣周漏、血管并发症、永久性起搏器植入、卒中、心肌梗死、冠状动脉口堵塞、瓣环断裂、主动脉夹层、新发心房颤动等TAVI并发症仍需高度重视。其中,瓣周漏越来越受到关注,研究表明瓣周漏与晚期死亡率的增加相关,主动脉瓣反流对死亡率的影响与反流严重程度成正比。

为减少瓣周漏、血管并发症、心脏起搏器植入、卒中和冠状动脉口堵塞等并发症,克服不可再定位和回收等缺点,新型瓣膜不断涌现,包括Sapien III(Edwards Lifesciences)、Centera(Edwards Lifesciences)、CoreValveEvolut(Medtronic)、Engager(Medtronic)、Lotusvalve(Boston Scientific)、Direct Flow(Direct Flow)、Jena Valve(Jena Valve)、Portico(St.Jude)、Accurate(Symetis)等。

二、经导管二尖瓣修复术

近年来经导管微创介入治疗二尖瓣反流(MR)越来越引起人们的关注,二尖瓣任一结构(瓣叶、乳头肌、腱索、瓣环)的病变均会导致MR。经导管二尖瓣修复术采用的技术理念类似于外科手术,如“缘对缘”二尖瓣修复术和瓣环成形术等。

截至目前,经导管二尖瓣修复术(TMVR)有以下几种方式:间接二尖瓣瓣环成形术(Carillon system and Cerclageannuloplasty),直接二尖瓣瓣环成形术(Mitralign system,GDS Accucinch and ValtechCardioband)缘对缘瓣膜修复术(MitraClip,Mitraflex),直接瓣叶和腱索消融术,腱索置入术(NeoChord,BabicChords),改善左心室重构(iCoapsys technique,Mardil-BACE system)和经导管二尖瓣置入(CardiAQ,Neovasc,Edwards Fortis and Tendyne)等。然而,除了MitraClip,上述技术应用较少,而且有些装置的并发症发生率高,因此目前临床上并未广泛使用。

MitraClip是基于1992年Otavio ALFIERI发明的“缘对缘”缝合技术,2003年首次进行了动物实验,2008年9月开始应用于临床。EVEREST研究证实MitraClip的安全性(并发症发生率低)和有效性(超过2/3的患者MR显著减轻),即使MitraClip操作失败了,手术仍然是替代治疗方案。多中心随机临床试验EVERESTII研究比较了MitraClip和外科手术的有效性和安全性,发现MitraClip治疗可减轻77%患者的MR,但主要终点劣于外科手术,主要由于约20%的患者因二尖瓣功能障碍需要外科手术。然而,EVEREST II高危组的研究提示,与常规治疗组相比,MitraClip能够改善患者临床症状,显著逆转左心室重构,提高1年生存率(76%:55%)。EVERESTII试验4年的随访结果显示,MitraClip组和手术组的复合终点率(未发生死亡、手术、3+或4+MR)分别为39.8%和53.4%,而两组患者的死亡率、3+或4+MR率并无差别。MitraClip治疗组患者更需要手术治疗残余的MR,但其主要发生于MitraClip治疗后1年内。

ACCESS-EUROPE研究发现MitraClip的成功置入率为99.6%。30天死亡率为3.4%,1年存活率为81.8%。1年随访发现,MitraClip能够显著改善MR和NYHA功能,仅6.3%的患者需要手术,表明MitraClip对手术高危的高龄患者是安全有效的。PERMIT-CARE investigation、TRAMI registry、GRASP registry、MitraSwiss registry等研究取得了类似结果。

三、新的心脏瓣膜疾病诊治指南发布

2012年欧洲心脏病学会/欧洲心胸外科学会(ESC/EACTS)心脏瓣膜疾病管理指南指出:TAVI可考虑应用于外科手术高危的重度症状性主动脉瓣狭窄患者,但需要一个“心脏团队”的综合分析评估与团队协作(IIa,B)对于外科手术禁忌患者,并且可能因TAVI改善生活质量,预期寿命超过1年的重度症状性主动脉瓣狭窄患者应行TAVI治疗(I,B)。2014年最新公布的美国心脏协会/美国心脏病学会(AHA/ACC)心脏瓣膜疾病指南也给予了一致的推荐。

此外,2014AHA/ACC指南的亮点还包括:①对心脏瓣膜疾病进行动态分期,建议根据瓣膜解剖学结构、血流动力学、血流动力学改变导致的结果以及有无症状将心脏瓣膜疾病分为危险期(A期)、进展期(B期)、无症状性重度病变期(C期)和症状性重度病变期(D期),不同分期采取不同的治疗方式;②推荐成立心脏瓣膜团队,建立由介入医师、心血管外科医师、心血管影像医师、麻醉医师、心脏超生医师及护士等组成的心脏瓣膜团队,多学科合作,术前充分评估、讨论,选择最优的干预方式,并在术中、术后管理中相互支持,最大限度地保证患者安全;③手术风险评估方面建议在STS评分基础上增加身体虚弱程度、术后不能改善的主要受累器官和手术难度,使手术风险评估更加精确。

四、经导管心脏瓣膜介入治疗中国发展现状

在我国,自2010年葛均波院士成功完成了国内首例TAVI以来,多家中心相继尝试开展,截至目前,全国有11家中心开展TAVI手术,累计开展约250例。但是,TAVI在国内刚刚起步,不同地区和中心的发展不均衡,目前累计开展50例左右的中心仅3个。虽然国内的绝对例数不多,但每年均呈指数级增长,仅2014年TAVI的数量就多于150例,超过过去几年的总和。虽然中国二叶式主动脉瓣畸形(包括功能性)在TAVI手术中的占比接近50%,但手术的总体结果仍与国外报道类似,安全性和有效性在中国人群中得到证实。

令人欣喜的是,国产瓣膜的研究取得了突破,由阜外心血管病医院高润霖院士牵头的国家“十二五”攻关计划VENUSA国产瓣膜的临床试验已经完成了患者的入组工作,30天的随访结果非常理想。此外,还有两种国产瓣膜J Valve(经心尖途径)和Microport瓣膜正在进行临床试验。

与TAVI相比,MitraClip在国内的发展相对滞后,自2012年葛均波院士完成首例MitraClip手术以来,截至目前仅复旦大学附属中山医院和本中心开展,累计开展15例。但从本中心的11例结果来看,MitraClip的成功率为100%,30天生存率为91%,患者术后6分钟步行试验、生活质量评分、纽约心功能分级(NYHA)以及超声心动图随访均提示较术前有明显改善,因此初步经验表明MitraClip在中国人群中应用是安全有效的。

总之,近年来心脏瓣膜疾病的介入治疗取得了重要进展,虽然多项技术尚处于初始应用阶段,但毋庸置疑,经导管心脏瓣膜疾病的治疗前景广阔,越来越多的患者将从中获益。

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1715915, encodeId=8e1d1e1591585, content=<a href='/topic/show?id=2c375156e5f' target=_blank style='color:#2F92EE;'>#心脏瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51567, encryptionId=2c375156e5f, topicName=心脏瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b6d32099965, createdName=jianjun77, createdTime=Thu Jan 28 11:58:00 CST 2016, time=2016-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19553, encodeId=85a61955353, content=期待, beContent=null, objectType=article, channel=null, level=null, likeNumber=128, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9daf1619121, createdName=Keren1970, createdTime=Sun Apr 05 20:53:00 CST 2015, time=2015-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510030, encodeId=3a371510030b6, content=<a href='/topic/show?id=e9bce8254ef' target=_blank style='color:#2F92EE;'>#经导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78254, encryptionId=e9bce8254ef, topicName=经导管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e010191378, createdName=lsj631, createdTime=Sun Apr 05 05:58:00 CST 2015, time=2015-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1583449, encodeId=5e05158344925, content=<a href='/topic/show?id=508d68e698c' target=_blank style='color:#2F92EE;'>#瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68769, encryptionId=508d68e698c, topicName=瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=58dc16986228, createdName=12498e5fm17(暂无昵称), createdTime=Sun Apr 05 05:58:00 CST 2015, time=2015-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19450, encodeId=90291945028, content=结论过于乐观吧?, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=Easttip, createdTime=Sat Apr 04 23:53:00 CST 2015, time=2015-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19314, encodeId=bea8193143b, content=well, beContent=null, objectType=article, channel=null, level=null, likeNumber=127, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=BiochemY, createdTime=Sat Apr 04 01:24:00 CST 2015, time=2015-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19302, encodeId=7b911930273, content=继续发展吧, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/03/28/a28e8ea268716dfc601012321847bccf.jpg, createdBy=e21a1620364, createdName=清氺訫, createdTime=Fri Apr 03 22:14:00 CST 2015, time=2015-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19303, encodeId=ce6219303f3, content=当初就以为搞心脏, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/03/28/a28e8ea268716dfc601012321847bccf.jpg, createdBy=e21a1620364, createdName=清氺訫, createdTime=Fri Apr 03 22:14:00 CST 2015, time=2015-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19295, encodeId=c7d41929549, content=跟着外国屁股走, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=hbwang006, createdTime=Fri Apr 03 21:57:00 CST 2015, time=2015-04-03, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=1715915, encodeId=8e1d1e1591585, content=<a href='/topic/show?id=2c375156e5f' target=_blank style='color:#2F92EE;'>#心脏瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51567, encryptionId=2c375156e5f, topicName=心脏瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b6d32099965, createdName=jianjun77, createdTime=Thu Jan 28 11:58:00 CST 2016, time=2016-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19553, encodeId=85a61955353, content=期待, beContent=null, objectType=article, channel=null, level=null, likeNumber=128, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9daf1619121, createdName=Keren1970, createdTime=Sun Apr 05 20:53:00 CST 2015, time=2015-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510030, encodeId=3a371510030b6, content=<a href='/topic/show?id=e9bce8254ef' target=_blank style='color:#2F92EE;'>#经导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78254, encryptionId=e9bce8254ef, topicName=经导管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e010191378, createdName=lsj631, createdTime=Sun Apr 05 05:58:00 CST 2015, time=2015-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1583449, encodeId=5e05158344925, content=<a href='/topic/show?id=508d68e698c' target=_blank style='color:#2F92EE;'>#瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68769, encryptionId=508d68e698c, topicName=瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=58dc16986228, createdName=12498e5fm17(暂无昵称), createdTime=Sun Apr 05 05:58:00 CST 2015, time=2015-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19450, encodeId=90291945028, content=结论过于乐观吧?, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=Easttip, createdTime=Sat Apr 04 23:53:00 CST 2015, time=2015-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19314, encodeId=bea8193143b, content=well, beContent=null, objectType=article, channel=null, level=null, likeNumber=127, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=BiochemY, createdTime=Sat Apr 04 01:24:00 CST 2015, time=2015-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19302, encodeId=7b911930273, content=继续发展吧, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/03/28/a28e8ea268716dfc601012321847bccf.jpg, createdBy=e21a1620364, createdName=清氺訫, createdTime=Fri Apr 03 22:14:00 CST 2015, time=2015-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19303, encodeId=ce6219303f3, content=当初就以为搞心脏, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/03/28/a28e8ea268716dfc601012321847bccf.jpg, createdBy=e21a1620364, createdName=清氺訫, createdTime=Fri Apr 03 22:14:00 CST 2015, time=2015-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19295, encodeId=c7d41929549, content=跟着外国屁股走, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=hbwang006, createdTime=Fri Apr 03 21:57:00 CST 2015, time=2015-04-03, status=1, ipAttribution=)]
    2015-04-05 Keren1970

    期待

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1715915, encodeId=8e1d1e1591585, content=<a href='/topic/show?id=2c375156e5f' target=_blank style='color:#2F92EE;'>#心脏瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51567, encryptionId=2c375156e5f, topicName=心脏瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b6d32099965, createdName=jianjun77, createdTime=Thu Jan 28 11:58:00 CST 2016, time=2016-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19553, encodeId=85a61955353, content=期待, beContent=null, objectType=article, channel=null, level=null, likeNumber=128, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9daf1619121, createdName=Keren1970, createdTime=Sun Apr 05 20:53:00 CST 2015, time=2015-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510030, encodeId=3a371510030b6, content=<a href='/topic/show?id=e9bce8254ef' target=_blank style='color:#2F92EE;'>#经导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78254, encryptionId=e9bce8254ef, topicName=经导管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e010191378, createdName=lsj631, createdTime=Sun Apr 05 05:58:00 CST 2015, time=2015-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1583449, encodeId=5e05158344925, content=<a href='/topic/show?id=508d68e698c' target=_blank style='color:#2F92EE;'>#瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68769, encryptionId=508d68e698c, topicName=瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=58dc16986228, createdName=12498e5fm17(暂无昵称), createdTime=Sun Apr 05 05:58:00 CST 2015, time=2015-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19450, encodeId=90291945028, content=结论过于乐观吧?, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=Easttip, createdTime=Sat Apr 04 23:53:00 CST 2015, time=2015-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19314, encodeId=bea8193143b, content=well, beContent=null, objectType=article, channel=null, level=null, likeNumber=127, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=BiochemY, createdTime=Sat Apr 04 01:24:00 CST 2015, time=2015-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19302, encodeId=7b911930273, content=继续发展吧, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/03/28/a28e8ea268716dfc601012321847bccf.jpg, createdBy=e21a1620364, createdName=清氺訫, createdTime=Fri Apr 03 22:14:00 CST 2015, time=2015-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19303, encodeId=ce6219303f3, content=当初就以为搞心脏, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/03/28/a28e8ea268716dfc601012321847bccf.jpg, createdBy=e21a1620364, createdName=清氺訫, createdTime=Fri Apr 03 22:14:00 CST 2015, time=2015-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19295, encodeId=c7d41929549, content=跟着外国屁股走, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=hbwang006, createdTime=Fri Apr 03 21:57:00 CST 2015, time=2015-04-03, status=1, ipAttribution=)]
    2015-04-05 lsj631
  4. [GetPortalCommentsPageByObjectIdResponse(id=1715915, encodeId=8e1d1e1591585, content=<a href='/topic/show?id=2c375156e5f' target=_blank style='color:#2F92EE;'>#心脏瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51567, encryptionId=2c375156e5f, topicName=心脏瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b6d32099965, createdName=jianjun77, createdTime=Thu Jan 28 11:58:00 CST 2016, time=2016-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19553, encodeId=85a61955353, content=期待, beContent=null, objectType=article, channel=null, level=null, likeNumber=128, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9daf1619121, createdName=Keren1970, createdTime=Sun Apr 05 20:53:00 CST 2015, time=2015-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510030, encodeId=3a371510030b6, content=<a href='/topic/show?id=e9bce8254ef' target=_blank style='color:#2F92EE;'>#经导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78254, encryptionId=e9bce8254ef, topicName=经导管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e010191378, createdName=lsj631, createdTime=Sun Apr 05 05:58:00 CST 2015, time=2015-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1583449, encodeId=5e05158344925, content=<a href='/topic/show?id=508d68e698c' target=_blank style='color:#2F92EE;'>#瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68769, encryptionId=508d68e698c, topicName=瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=58dc16986228, createdName=12498e5fm17(暂无昵称), createdTime=Sun Apr 05 05:58:00 CST 2015, time=2015-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19450, encodeId=90291945028, content=结论过于乐观吧?, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=Easttip, createdTime=Sat Apr 04 23:53:00 CST 2015, time=2015-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19314, encodeId=bea8193143b, content=well, beContent=null, objectType=article, channel=null, level=null, likeNumber=127, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=BiochemY, createdTime=Sat Apr 04 01:24:00 CST 2015, time=2015-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19302, encodeId=7b911930273, content=继续发展吧, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/03/28/a28e8ea268716dfc601012321847bccf.jpg, createdBy=e21a1620364, createdName=清氺訫, createdTime=Fri Apr 03 22:14:00 CST 2015, time=2015-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19303, encodeId=ce6219303f3, content=当初就以为搞心脏, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/03/28/a28e8ea268716dfc601012321847bccf.jpg, createdBy=e21a1620364, createdName=清氺訫, createdTime=Fri Apr 03 22:14:00 CST 2015, time=2015-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19295, encodeId=c7d41929549, content=跟着外国屁股走, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=hbwang006, createdTime=Fri Apr 03 21:57:00 CST 2015, time=2015-04-03, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1715915, encodeId=8e1d1e1591585, content=<a href='/topic/show?id=2c375156e5f' target=_blank style='color:#2F92EE;'>#心脏瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51567, encryptionId=2c375156e5f, topicName=心脏瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b6d32099965, createdName=jianjun77, createdTime=Thu Jan 28 11:58:00 CST 2016, time=2016-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19553, encodeId=85a61955353, content=期待, beContent=null, objectType=article, channel=null, level=null, likeNumber=128, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9daf1619121, createdName=Keren1970, createdTime=Sun Apr 05 20:53:00 CST 2015, time=2015-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510030, encodeId=3a371510030b6, content=<a href='/topic/show?id=e9bce8254ef' target=_blank style='color:#2F92EE;'>#经导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78254, encryptionId=e9bce8254ef, topicName=经导管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e010191378, createdName=lsj631, createdTime=Sun Apr 05 05:58:00 CST 2015, time=2015-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1583449, encodeId=5e05158344925, content=<a href='/topic/show?id=508d68e698c' target=_blank style='color:#2F92EE;'>#瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68769, encryptionId=508d68e698c, topicName=瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=58dc16986228, createdName=12498e5fm17(暂无昵称), createdTime=Sun Apr 05 05:58:00 CST 2015, time=2015-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19450, encodeId=90291945028, content=结论过于乐观吧?, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=Easttip, createdTime=Sat Apr 04 23:53:00 CST 2015, time=2015-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19314, encodeId=bea8193143b, content=well, beContent=null, objectType=article, channel=null, level=null, likeNumber=127, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=BiochemY, createdTime=Sat Apr 04 01:24:00 CST 2015, time=2015-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19302, encodeId=7b911930273, content=继续发展吧, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/03/28/a28e8ea268716dfc601012321847bccf.jpg, createdBy=e21a1620364, createdName=清氺訫, createdTime=Fri Apr 03 22:14:00 CST 2015, time=2015-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19303, encodeId=ce6219303f3, content=当初就以为搞心脏, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/03/28/a28e8ea268716dfc601012321847bccf.jpg, createdBy=e21a1620364, createdName=清氺訫, createdTime=Fri Apr 03 22:14:00 CST 2015, time=2015-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19295, encodeId=c7d41929549, content=跟着外国屁股走, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=hbwang006, createdTime=Fri Apr 03 21:57:00 CST 2015, time=2015-04-03, status=1, ipAttribution=)]
    2015-04-04 Easttip

    结论过于乐观吧?

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1715915, encodeId=8e1d1e1591585, content=<a href='/topic/show?id=2c375156e5f' target=_blank style='color:#2F92EE;'>#心脏瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51567, encryptionId=2c375156e5f, topicName=心脏瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b6d32099965, createdName=jianjun77, createdTime=Thu Jan 28 11:58:00 CST 2016, time=2016-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19553, encodeId=85a61955353, content=期待, beContent=null, objectType=article, channel=null, level=null, likeNumber=128, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9daf1619121, createdName=Keren1970, createdTime=Sun Apr 05 20:53:00 CST 2015, time=2015-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510030, encodeId=3a371510030b6, content=<a href='/topic/show?id=e9bce8254ef' target=_blank style='color:#2F92EE;'>#经导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78254, encryptionId=e9bce8254ef, topicName=经导管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e010191378, createdName=lsj631, createdTime=Sun Apr 05 05:58:00 CST 2015, time=2015-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1583449, encodeId=5e05158344925, content=<a href='/topic/show?id=508d68e698c' target=_blank style='color:#2F92EE;'>#瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68769, encryptionId=508d68e698c, topicName=瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=58dc16986228, createdName=12498e5fm17(暂无昵称), createdTime=Sun Apr 05 05:58:00 CST 2015, time=2015-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19450, encodeId=90291945028, content=结论过于乐观吧?, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=Easttip, createdTime=Sat Apr 04 23:53:00 CST 2015, time=2015-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19314, encodeId=bea8193143b, content=well, beContent=null, objectType=article, channel=null, level=null, likeNumber=127, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=BiochemY, createdTime=Sat Apr 04 01:24:00 CST 2015, time=2015-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19302, encodeId=7b911930273, content=继续发展吧, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/03/28/a28e8ea268716dfc601012321847bccf.jpg, createdBy=e21a1620364, createdName=清氺訫, createdTime=Fri Apr 03 22:14:00 CST 2015, time=2015-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19303, encodeId=ce6219303f3, content=当初就以为搞心脏, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/03/28/a28e8ea268716dfc601012321847bccf.jpg, createdBy=e21a1620364, createdName=清氺訫, createdTime=Fri Apr 03 22:14:00 CST 2015, time=2015-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19295, encodeId=c7d41929549, content=跟着外国屁股走, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=hbwang006, createdTime=Fri Apr 03 21:57:00 CST 2015, time=2015-04-03, status=1, ipAttribution=)]
    2015-04-04 BiochemY

    well

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1715915, encodeId=8e1d1e1591585, content=<a href='/topic/show?id=2c375156e5f' target=_blank style='color:#2F92EE;'>#心脏瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51567, encryptionId=2c375156e5f, topicName=心脏瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b6d32099965, createdName=jianjun77, createdTime=Thu Jan 28 11:58:00 CST 2016, time=2016-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19553, encodeId=85a61955353, content=期待, beContent=null, objectType=article, channel=null, level=null, likeNumber=128, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9daf1619121, createdName=Keren1970, createdTime=Sun Apr 05 20:53:00 CST 2015, time=2015-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510030, encodeId=3a371510030b6, content=<a href='/topic/show?id=e9bce8254ef' target=_blank style='color:#2F92EE;'>#经导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78254, encryptionId=e9bce8254ef, topicName=经导管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e010191378, createdName=lsj631, createdTime=Sun Apr 05 05:58:00 CST 2015, time=2015-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1583449, encodeId=5e05158344925, content=<a href='/topic/show?id=508d68e698c' target=_blank style='color:#2F92EE;'>#瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68769, encryptionId=508d68e698c, topicName=瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=58dc16986228, createdName=12498e5fm17(暂无昵称), createdTime=Sun Apr 05 05:58:00 CST 2015, time=2015-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19450, encodeId=90291945028, content=结论过于乐观吧?, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=Easttip, createdTime=Sat Apr 04 23:53:00 CST 2015, time=2015-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19314, encodeId=bea8193143b, content=well, beContent=null, objectType=article, channel=null, level=null, likeNumber=127, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=BiochemY, createdTime=Sat Apr 04 01:24:00 CST 2015, time=2015-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19302, encodeId=7b911930273, content=继续发展吧, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/03/28/a28e8ea268716dfc601012321847bccf.jpg, createdBy=e21a1620364, createdName=清氺訫, createdTime=Fri Apr 03 22:14:00 CST 2015, time=2015-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19303, encodeId=ce6219303f3, content=当初就以为搞心脏, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/03/28/a28e8ea268716dfc601012321847bccf.jpg, createdBy=e21a1620364, createdName=清氺訫, createdTime=Fri Apr 03 22:14:00 CST 2015, time=2015-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19295, encodeId=c7d41929549, content=跟着外国屁股走, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=hbwang006, createdTime=Fri Apr 03 21:57:00 CST 2015, time=2015-04-03, status=1, ipAttribution=)]
    2015-04-03 清氺訫

    继续发展吧

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1715915, encodeId=8e1d1e1591585, content=<a href='/topic/show?id=2c375156e5f' target=_blank style='color:#2F92EE;'>#心脏瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51567, encryptionId=2c375156e5f, topicName=心脏瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b6d32099965, createdName=jianjun77, createdTime=Thu Jan 28 11:58:00 CST 2016, time=2016-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19553, encodeId=85a61955353, content=期待, beContent=null, objectType=article, channel=null, level=null, likeNumber=128, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9daf1619121, createdName=Keren1970, createdTime=Sun Apr 05 20:53:00 CST 2015, time=2015-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510030, encodeId=3a371510030b6, content=<a href='/topic/show?id=e9bce8254ef' target=_blank style='color:#2F92EE;'>#经导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78254, encryptionId=e9bce8254ef, topicName=经导管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e010191378, createdName=lsj631, createdTime=Sun Apr 05 05:58:00 CST 2015, time=2015-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1583449, encodeId=5e05158344925, content=<a href='/topic/show?id=508d68e698c' target=_blank style='color:#2F92EE;'>#瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68769, encryptionId=508d68e698c, topicName=瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=58dc16986228, createdName=12498e5fm17(暂无昵称), createdTime=Sun Apr 05 05:58:00 CST 2015, time=2015-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19450, encodeId=90291945028, content=结论过于乐观吧?, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=Easttip, createdTime=Sat Apr 04 23:53:00 CST 2015, time=2015-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19314, encodeId=bea8193143b, content=well, beContent=null, objectType=article, channel=null, level=null, likeNumber=127, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=BiochemY, createdTime=Sat Apr 04 01:24:00 CST 2015, time=2015-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19302, encodeId=7b911930273, content=继续发展吧, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/03/28/a28e8ea268716dfc601012321847bccf.jpg, createdBy=e21a1620364, createdName=清氺訫, createdTime=Fri Apr 03 22:14:00 CST 2015, time=2015-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19303, encodeId=ce6219303f3, content=当初就以为搞心脏, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/03/28/a28e8ea268716dfc601012321847bccf.jpg, createdBy=e21a1620364, createdName=清氺訫, createdTime=Fri Apr 03 22:14:00 CST 2015, time=2015-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19295, encodeId=c7d41929549, content=跟着外国屁股走, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=hbwang006, createdTime=Fri Apr 03 21:57:00 CST 2015, time=2015-04-03, status=1, ipAttribution=)]
    2015-04-03 清氺訫

    当初就以为搞心脏

    0

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    2015-04-03 hbwang006

    跟着外国屁股走

    0