“过度保胎”会增加胎儿畸形风险吗?

2016-04-12 郭铭川 郭大夫科普时间

多项研究都表明,使用黄体酮或者地屈孕酮保胎并不增加胎儿畸形风险。作者:郭铭川来源:郭大夫科普时间妊娠既然是优胜劣汰、优中选优,然而现实生活中因为种种原因,过度保胎的现象层出不穷。很多人开始担心,这样在妊娠早期用这么多药安全吗?会引起胎儿畸形吗?会不会把本来有问题该被淘汰的胎儿给保下来,然后导致有问题的胎儿出生?更有人责怪医生,认为有的医生就是医德败坏,想给病人多开药。这些想法都不对。先说说积极

多项研究都表明,使用黄体酮或者地屈孕酮保胎并不增加胎儿畸形风险。

作者:郭铭川
来源:郭大夫科普时间

妊娠既然是优胜劣汰、优中选优,然而现实生活中因为种种原因,过度保胎的现象层出不穷。很多人开始担心,这样在妊娠早期用这么多药安全吗?会引起胎儿畸形吗?会不会把本来有问题该被淘汰的胎儿给保下来,然后导致有问题的胎儿出生?更有人责怪医生,认为有的医生就是医德败坏,想给病人多开药。这些想法都不对。

先说说积极保胎的理由!

看过我过去旧文的朋友,都很清楚,其实我是反对动辄孕早期保胎的。但是我在反对孕早期动辄保胎的同时,还表达了一个观点,如果保胎,就宁左勿右。意思是,如果要保胎,我会支持你“过度保胎”。如何理解这个问题?主要有三大理由。

第一,解决孕妇焦虑心理的理由。

孕早期任何症状的出现,任何检查指标的异常,都会造成孕妇的“流产”焦虑。我们很难去预测她是不是会发生流产,我们也很难给所谓“先兆流产”进行严格的限定,什么时候用药,什么时候不用药,也是无法以是非黑白来界定的。用药,会不会有“过度保胎”的嫌疑?不用药,万一流产了怎么办?医生你赔得起?并不是每个医生都能准确把控患者的心理(医生忙,也没时间去把控),也并不是每个患者的心理都能接受医生的把控。而保胎措施的获取相对容易,即便是“过度保胎”,也不会有什么危害,但是却能消除患者的焦虑。“至少我是保了,那就算还是流产了,也只能怪运气不好。”

现在普遍都是晚婚晚育,并且很多人在决定生这一胎之前,都有过人流、药流的经历,虽然没有复发性流产的病史,但是大家都很担心这个胎儿会流产,迫切希望能留住这一胎。我曾反复在过去的文章中强调,“怀孕就像考试,妊娠就是试错”,“人类胚胎是优中选优”、“胎儿好,是它自己好,不会因为我们做个什么它就不好了;胎儿不好是它自己不好,本来就不好的胎儿,更加不可能我们做个什么就把它变正常了”。所有这些语言,也都是为了让大家认清妊娠的本质,告诉大家很多事情不是在我们掌中之中的,多余的焦虑和担心都是徒劳。然而很现实情况是,多数医生没有时间来给病人做这样的解释,由于很多晚育人群,都存在想怀孕的急迫心态,早孕的检出时间越来越早,过早检出的妊娠,是无法判别妊娠的部位、活性的(就是说不知道是宫内孕还是宫外孕,不知道是死胎还是活胎)。出于安全考虑,医生往往会建议更频繁的抽血化验,而我们经常会看到一些模棱两可的化验结果,比如孕酮偏低,比如孕酮水平忽高忽低。面对这些结果,医生无法给出准确解释,只能说“可能xxx”、“也可能xxx”,而更深入的解释,就没有了。中国医生都很忙,一上午看几十个号再平常不过了,哪里有时间解决病人的焦虑。物价局对医疗的定价,也只定了“医疗”的价格,并没有“服务”的价格,所以提到“医疗服务”,在我们国家,就只有“医疗”,没有“服务”。香港医生为什么服务态度好,话多,因为多听他们说句话都是要给钱的。在这样的背景下,解决患者焦虑最简单高效的办法,就是积极上保胎药。

第二,流产高危因素确实也普遍存在。

首先要明确“高危因素”的概念,所谓高危因素,存在A情况的人,发生B风险的比例更高。而高危因素对医生的意义和对患者的意义是不一样的,对医生,这是个群体概率,关系到我将来可能会面临更多B风险的病人,而对患者,只存在发生B风险和不发生B风险两种可能性。所以,概率对患者是没有实际意义的。而这些所谓高危因素,实际上也都是小概率事件。

常见的高危因素包括:高龄、既往人流史、多囊卵巢综合征、卵泡发育不良、糖尿病、甲功异常等。虽然存在这些高危因素的人,绝大多数并不会发生自然流产,但是有研究认为,存在这些因素的人中,发生自然流产风险的可能性确实会高一些。我们无法知晓眼前这位是否会因为这些高危因素流产,只能用事实去验证,她真的反复发生了,那才考虑可能是这个原因,然而依然都无法确定就一定是这个原因。但是,很多人不愿意去经历这样的验证,怕输。

但是,无论如何都不要忘记,妊娠早期的自然流产,绝大多数是属于胚胎的自然淘汰,无论是否有高危因素的存在,自然选择的力量永远是占据绝对优势的。

第三,假设我们所担心的问题确实存在,“过度保胎”的说法自然就不成立了。

对于存在流产风险的妊娠,整个孕早期其实都是有风险的。因为妊娠在头三个月最不稳定,最容易受干扰,最容易因为各种诱因发生流产或者保胎失败。与其把药量调来调去,在停药与不停药之间反复纠结,还不如一保到底,直接杀到孕中期来得安稳。

黄体酮或者地屈孕酮本身并不致畸

多项研究都表明,使用黄体酮或者地屈孕酮保胎并不增加胎儿畸形风险。(注意:是不增加,而不是不发生。不用这些保胎药,也会有畸形儿出现,因此用黄体酮或者地屈孕酮后,发生的畸形并不能怪责于用药)。

“过度保胎”在现实生活中的风靡,也证明了这一点。我们时常在抱怨,医生动不动就开孕激素保胎,但是极少有人听说因为用这些保胎药导致畸形的事件。

曾经有人担心黄体酮部分微弱的雄激素作用,可能导致女胎的男性化,而在多项研究中,这个观点也未得到证实。因此,担心保胎导致女胎男性化的问题目前是没有依据的。

因为胚胎自身缺陷问题,用了保胎药,并不会造成缺陷儿的出生。

有人担心,如果胚胎自身有缺陷,本来就是要自然流产的,现在用了保胎药,会不会就让他有机会存活下来,从而造成畸形率增加呢?

这也是没有依据的。达到自然淘汰标准的缺陷胚胎,往往是致命性的缺陷,而孕激素保胎的作用机理是作用于母体,包括使子宫平滑肌易于舒张、促进内膜发育促进着床稳定等,它并不作用于胎儿。孕激素保胎,可能能让胚胎在子宫内呆更久,但是并不能改变其死亡结局。它被淘汰的理由,是它自身无法存活,是它的自身构造和DNA决定了它无法存活,而胚胎的自身构造和DNA显然是不可能被我们通过什么手段能改变的,因而也就不存在保胎就能让它活下来的道理。

很多事儿,做了就别去后悔,到底怎么样是对的都还不一定呢!无论你社会地位多牛逼,无论你多有钱,毕竟,作为自然人活在这个世界上,在大自然面前,我们永远是被动的。我有我的原则,你有你的顾虑;你的顾虑,在我的原则面前也许是多余的,而我的“原则”,今天是“原则”,到了明天,或者换个场景,或者换个人,还不知道是啥呢。所以,我更相信自然法则,哪怕我死了,那也是老天爷定的,这本来就是迟早的事儿。

“世上本无事,庸人自扰之!”还是想想今天的晚餐该吃点啥吧。

作者:郭铭川,妇产科医生,首发于微信公众号“郭大夫科普时间”

新浪微博:@铭医铭言

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    2018-01-06 complicatehq

    很好.解了我心中的疑虑.作为保胎中的准妈妈我要为宝宝努力下!

    0

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    2016-04-20 lujingqiao

    很好,又可以少些顾虑了

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=275974, encodeId=5b342e5974d2, content=很好.解了我心中的疑虑.作为保胎中的准妈妈我要为宝宝努力下!, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/B12F553DFF7216F18ACF46FAAB5AF1FD/100, createdBy=2cc02040702, createdName=complicatehq, createdTime=Sat Jan 06 11:23:46 CST 2018, time=2018-01-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=79761, encodeId=f905e9761fd, content=很好,又可以少些顾虑了, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ac1e76412, createdName=lujingqiao, createdTime=Wed Apr 20 11:04:00 CST 2016, time=2016-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=77990, encodeId=9162e79909b, content=文章值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=177, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Thu Apr 14 18:13:00 CST 2016, time=2016-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=77991, encodeId=e97ee7991e3, content=很好,加油, beContent=null, objectType=article, channel=null, level=null, likeNumber=147, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Thu Apr 14 18:13:00 CST 2016, time=2016-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=77806, encodeId=1714e7806a9, content=学习了 长知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/PiajxSqBRaEJJAFMgSjibMicGVUgkmDBw4svXiccQxZicwjRHNxGPTghAmITxP12Rcmm0yFKfwGwUaiaUwpPUUUTOd2g/0, createdBy=fcd21609070, createdName=hekzn, createdTime=Thu Apr 14 10:00:00 CST 2016, time=2016-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1362137, encodeId=be8f136213e37, content=<a href='/topic/show?id=9857e03444b' target=_blank style='color:#2F92EE;'>#畸形#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70344, encryptionId=9857e03444b, topicName=畸形)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ca20190, createdName=wushaoling, createdTime=Thu Apr 14 02:48:00 CST 2016, time=2016-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1581576, encodeId=50be15815e6d2, content=<a href='/topic/show?id=134f8361e77' target=_blank style='color:#2F92EE;'>#胎儿畸形#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83617, encryptionId=134f8361e77, topicName=胎儿畸形)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5d1416824653, createdName=ms1756883563247400, createdTime=Thu Apr 14 02:48:00 CST 2016, time=2016-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=77703, encodeId=1f7ae770359, content=世上本无事, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIuqOuvZLWMJ8yAVHKNPBSKWLKHx7ibIhutJv2OfnTK9MQH5jpicpw5EJTmD0M0q2wOG3CZO9wTxa9A/132, createdBy=75561684788, createdName=yilibaisha, createdTime=Wed Apr 13 19:33:00 CST 2016, time=2016-04-13, status=1, ipAttribution=)]
    2016-04-14 李继凯

    文章值得学习

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=275974, encodeId=5b342e5974d2, content=很好.解了我心中的疑虑.作为保胎中的准妈妈我要为宝宝努力下!, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/B12F553DFF7216F18ACF46FAAB5AF1FD/100, createdBy=2cc02040702, createdName=complicatehq, createdTime=Sat Jan 06 11:23:46 CST 2018, time=2018-01-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=79761, encodeId=f905e9761fd, content=很好,又可以少些顾虑了, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ac1e76412, createdName=lujingqiao, createdTime=Wed Apr 20 11:04:00 CST 2016, time=2016-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=77990, encodeId=9162e79909b, content=文章值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=177, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Thu Apr 14 18:13:00 CST 2016, time=2016-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=77991, encodeId=e97ee7991e3, content=很好,加油, beContent=null, objectType=article, channel=null, level=null, likeNumber=147, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Thu Apr 14 18:13:00 CST 2016, time=2016-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=77806, encodeId=1714e7806a9, content=学习了 长知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/PiajxSqBRaEJJAFMgSjibMicGVUgkmDBw4svXiccQxZicwjRHNxGPTghAmITxP12Rcmm0yFKfwGwUaiaUwpPUUUTOd2g/0, createdBy=fcd21609070, createdName=hekzn, createdTime=Thu Apr 14 10:00:00 CST 2016, time=2016-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1362137, encodeId=be8f136213e37, content=<a href='/topic/show?id=9857e03444b' target=_blank style='color:#2F92EE;'>#畸形#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70344, encryptionId=9857e03444b, topicName=畸形)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ca20190, createdName=wushaoling, createdTime=Thu Apr 14 02:48:00 CST 2016, time=2016-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1581576, encodeId=50be15815e6d2, content=<a href='/topic/show?id=134f8361e77' target=_blank style='color:#2F92EE;'>#胎儿畸形#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83617, encryptionId=134f8361e77, topicName=胎儿畸形)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5d1416824653, createdName=ms1756883563247400, createdTime=Thu Apr 14 02:48:00 CST 2016, time=2016-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=77703, encodeId=1f7ae770359, content=世上本无事, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIuqOuvZLWMJ8yAVHKNPBSKWLKHx7ibIhutJv2OfnTK9MQH5jpicpw5EJTmD0M0q2wOG3CZO9wTxa9A/132, createdBy=75561684788, createdName=yilibaisha, createdTime=Wed Apr 13 19:33:00 CST 2016, time=2016-04-13, status=1, ipAttribution=)]
    2016-04-14 李继凯

    很好,加油

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=275974, encodeId=5b342e5974d2, content=很好.解了我心中的疑虑.作为保胎中的准妈妈我要为宝宝努力下!, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/B12F553DFF7216F18ACF46FAAB5AF1FD/100, createdBy=2cc02040702, createdName=complicatehq, createdTime=Sat Jan 06 11:23:46 CST 2018, time=2018-01-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=79761, encodeId=f905e9761fd, content=很好,又可以少些顾虑了, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ac1e76412, createdName=lujingqiao, createdTime=Wed Apr 20 11:04:00 CST 2016, time=2016-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=77990, encodeId=9162e79909b, content=文章值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=177, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Thu Apr 14 18:13:00 CST 2016, time=2016-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=77991, encodeId=e97ee7991e3, content=很好,加油, beContent=null, objectType=article, channel=null, level=null, likeNumber=147, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Thu Apr 14 18:13:00 CST 2016, time=2016-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=77806, encodeId=1714e7806a9, content=学习了 长知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/PiajxSqBRaEJJAFMgSjibMicGVUgkmDBw4svXiccQxZicwjRHNxGPTghAmITxP12Rcmm0yFKfwGwUaiaUwpPUUUTOd2g/0, createdBy=fcd21609070, createdName=hekzn, createdTime=Thu Apr 14 10:00:00 CST 2016, time=2016-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1362137, encodeId=be8f136213e37, content=<a href='/topic/show?id=9857e03444b' target=_blank style='color:#2F92EE;'>#畸形#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70344, encryptionId=9857e03444b, topicName=畸形)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ca20190, createdName=wushaoling, createdTime=Thu Apr 14 02:48:00 CST 2016, time=2016-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1581576, encodeId=50be15815e6d2, content=<a href='/topic/show?id=134f8361e77' target=_blank style='color:#2F92EE;'>#胎儿畸形#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83617, encryptionId=134f8361e77, topicName=胎儿畸形)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5d1416824653, createdName=ms1756883563247400, createdTime=Thu Apr 14 02:48:00 CST 2016, time=2016-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=77703, encodeId=1f7ae770359, content=世上本无事, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIuqOuvZLWMJ8yAVHKNPBSKWLKHx7ibIhutJv2OfnTK9MQH5jpicpw5EJTmD0M0q2wOG3CZO9wTxa9A/132, createdBy=75561684788, createdName=yilibaisha, createdTime=Wed Apr 13 19:33:00 CST 2016, time=2016-04-13, status=1, ipAttribution=)]
    2016-04-14 hekzn

    学习了 长知识

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=275974, encodeId=5b342e5974d2, content=很好.解了我心中的疑虑.作为保胎中的准妈妈我要为宝宝努力下!, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/B12F553DFF7216F18ACF46FAAB5AF1FD/100, createdBy=2cc02040702, createdName=complicatehq, createdTime=Sat Jan 06 11:23:46 CST 2018, time=2018-01-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=79761, encodeId=f905e9761fd, content=很好,又可以少些顾虑了, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ac1e76412, createdName=lujingqiao, createdTime=Wed Apr 20 11:04:00 CST 2016, time=2016-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=77990, encodeId=9162e79909b, content=文章值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=177, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Thu Apr 14 18:13:00 CST 2016, time=2016-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=77991, encodeId=e97ee7991e3, content=很好,加油, beContent=null, objectType=article, channel=null, level=null, likeNumber=147, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Thu Apr 14 18:13:00 CST 2016, time=2016-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=77806, encodeId=1714e7806a9, content=学习了 长知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/PiajxSqBRaEJJAFMgSjibMicGVUgkmDBw4svXiccQxZicwjRHNxGPTghAmITxP12Rcmm0yFKfwGwUaiaUwpPUUUTOd2g/0, createdBy=fcd21609070, createdName=hekzn, createdTime=Thu Apr 14 10:00:00 CST 2016, time=2016-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1362137, encodeId=be8f136213e37, content=<a href='/topic/show?id=9857e03444b' target=_blank style='color:#2F92EE;'>#畸形#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70344, encryptionId=9857e03444b, topicName=畸形)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ca20190, createdName=wushaoling, createdTime=Thu Apr 14 02:48:00 CST 2016, time=2016-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1581576, encodeId=50be15815e6d2, content=<a href='/topic/show?id=134f8361e77' target=_blank style='color:#2F92EE;'>#胎儿畸形#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83617, encryptionId=134f8361e77, topicName=胎儿畸形)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5d1416824653, createdName=ms1756883563247400, createdTime=Thu Apr 14 02:48:00 CST 2016, time=2016-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=77703, encodeId=1f7ae770359, content=世上本无事, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIuqOuvZLWMJ8yAVHKNPBSKWLKHx7ibIhutJv2OfnTK9MQH5jpicpw5EJTmD0M0q2wOG3CZO9wTxa9A/132, createdBy=75561684788, createdName=yilibaisha, createdTime=Wed Apr 13 19:33:00 CST 2016, time=2016-04-13, status=1, ipAttribution=)]
    2016-04-14 wushaoling
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    2016-04-13 yilibaisha

    世上本无事

    0

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