郭艺芳:SGLT-2抑制剂——具有降糖作用的降压药

2015-12-03 郭艺芳 郭艺芳微博

2015年EASD年会期间公布EMPA-REG研究结果以后,迅即在囯内外引起广泛关注。该研究显示,在常规治疗基础上应用SGLT-2抑制剂恩格列净治疗,可显著降低确诊心血管疾病的2型糖尿病患者的心血管死亡率与全因死亡率。因为这是首项证实降糖药物可以降低临床心血管终点事件发生率的临床研究,因而被视为具有里程碑意义的降糖药物试验。然而迄今为止,关于恩格列净的获益机制仍然莫衷一是。目前可以肯定的是,血糖水

2015年EASD年会期间公布EMPA-REG研究结果以后,迅即在囯内外引起广泛关注。该研究显示,在常规治疗基础上应用SGLT-2抑制剂恩格列净治疗,可显著降低确诊心血管疾病的2型糖尿病患者的心血管死亡率与全因死亡率。因为这是首项证实降糖药物可以降低临床心血管终点事件发生率的临床研究,因而被视为具有里程碑意义的降糖药物试验。然而迄今为止,关于恩格列净的获益机制仍然莫衷一是。目前可以肯定的是,血糖水平的降低肯定不是心血管事件减少的主要原因。由于在该研究中恩格列净治疗组受试者较安慰剂组血圧下降约4/2 mmHg,因此很多学者推测,该药的降压作用可能是其获益的主要原因之一。


11月24日,Lancet Diabetes Endocrinology杂志在线发表了Weber等人完成的一项关于达格列净的研究结果证实该药具有肯定的降压疗效。该研究采用随机化双盲安慰剂对照设计,共入选来自16个囯家311个中心的449例患者。受试者均确诊糖尿病(HbA1c 7.0%-10.5%)与高血压(血压140-165/85-105 mmHg)。在常规降压降糖治疗基础上将患者随机纳入达格列净组(225例)与安慰剂组(224例)。主要终点为坐位收缩压降低幅度与HbA1c下降幅度。结果显示,与安慰剂组患者相比,达格列净组患者收缩压降低4.28 mmHg(p=0.0002),HbA1c降低61%(p<0.0001)。事后分析发现,正在接受β-受体阻滞剂或钙通道阻滞剂治疗的患者血压下降幅度较大(分别为5.76与5.13mmHg),而接受噻嗪类利尿剂治疗的受试者血压降幅较小(2.38 mmHg)。达格列净组与安慰剂组不良事件发生率无显著差异。该研究结论认为,达格列净具有显著的降糖与降压作用,且安全性良好。此前已有多项研究发现SGLT-2抑制剂具有一定降压作用,本研究再次以更为严谨的研究设计论证了达格列净的降压效果。此类药物的降压作用很可能是通过渗透利尿作用实现的,在前述研究中,正在接受利尿剂治疗的受试者血压下降幅度较小正说明同样问题。


虽然毎种降压药物对于每例患者的降压作用可能有所不同,但从人群角度来看,常用—线降压药物的降压强度基本一致,并都符合以下规律:


收缩压下降幅度(mmHg)=9.1+0.1(基线收缩压-154)


按此规律推算,SGLT-2抑制剂的降压作用约为常用一线降压药物的一半左右。基于现有降压治疗临床试验,这一幅度的血压降幅足以产生显著的心血管获益。因此在EMPA-REG研究中恩格列净降低心血管终点事件的主要机制应该为血压的降低。


近20年来先后完成的HOT、SHEP、UKPDS、MICROHOPE、SYST-Eur、IDNT、RENAAL、PROGRESS、以及ADVANCE研究或其亚组分析有力证实,对于糖尿病患者,积极适度的降压治疗可以显著降低不良心血管终点事件的发生率。基于现有研究结论,在EMPA-REG研究中恩格列净治疗组主要复合终点事件显著减少,完全符合降压获益的一般规律。也正是基于上述考虑,SGLT-2抑制剂的心血管获益应该是类效应,而非恩格列净所特有的。


在EMPA-REG研究中,恩格列净治疗组患者既有血糖的降低,也有血压的降低。由于SGLT-2抑制剂以降糖药物的身份进入我们的视野,我们首先将其视为降糖药,但这并不能否认其具有降压药物的基本特征。从降糖药物的角度去分析恩格列净治疗组的心血管获益似乎存在诸多困惑之处。倘若将EMPA-REG研究视为一项降压治疗试验,其结果将会变得很容易理解。


因此,在庆贺我们多了一类可供选择的降糖药物的同时,更应该欢呼降压药物家族中又多了一位新成员。


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    2016-09-10 jklm09
  4. [GetPortalCommentsPageByObjectIdResponse(id=2081963, encodeId=03842081963b3, content=<a href='/topic/show?id=acf116218e6' target=_blank style='color:#2F92EE;'>#SGLT-2#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16218, encryptionId=acf116218e6, topicName=SGLT-2)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0a3a2500014, createdName=fmq_28614553, createdTime=Wed Aug 31 00:31:00 CST 2016, time=2016-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1995474, encodeId=142319954e45c, content=<a href='/topic/show?id=992411149e' target=_blank style='color:#2F92EE;'>#2抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1114, encryptionId=992411149e, topicName=2抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Mon Dec 07 07:31:00 CST 2015, time=2015-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1851275, encodeId=241918512e540, content=<a href='/topic/show?id=f0a254918f0' target=_blank style='color:#2F92EE;'>#抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Sat Sep 10 01:31:00 CST 2016, time=2016-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793901, encodeId=bad01e93901f0, content=<a href='/topic/show?id=722516221ec' target=_blank style='color:#2F92EE;'>#SGLT-2抑制#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16221, encryptionId=722516221ec, topicName=SGLT-2抑制)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=052a130, createdName=yyj062, createdTime=Wed Apr 06 10:31:00 CST 2016, time=2016-04-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793772, encodeId=2bf41e9377282, content=<a href='/topic/show?id=5a3f1621e7d' target=_blank style='color:#2F92EE;'>#SGLT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16217, encryptionId=5a3f1621e7d, topicName=SGLT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Sun Dec 20 11:31:00 CST 2015, time=2015-12-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55396, encodeId=0da35539699, content=好药,值得推广!, beContent=null, objectType=article, channel=null, level=null, likeNumber=178, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 23:32:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55393, encodeId=328f55393f3, content=好,, beContent=null, objectType=article, channel=null, level=null, likeNumber=134, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 23:31:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55394, encodeId=37315539411, content=不错!, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 23:31:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55395, encodeId=8ef05539549, content=新药,, beContent=null, objectType=article, channel=null, level=null, likeNumber=172, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 23:31:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=49101, encodeId=6cf3491010f, content=好文章,值得收藏, beContent=null, objectType=article, channel=null, level=null, likeNumber=181, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bc301610909, createdName=hixiaoluo, createdTime=Sun Dec 27 09:05:00 CST 2015, time=2015-12-27, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=2081963, encodeId=03842081963b3, content=<a href='/topic/show?id=acf116218e6' target=_blank style='color:#2F92EE;'>#SGLT-2#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16218, encryptionId=acf116218e6, topicName=SGLT-2)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0a3a2500014, createdName=fmq_28614553, createdTime=Wed Aug 31 00:31:00 CST 2016, time=2016-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1995474, encodeId=142319954e45c, content=<a href='/topic/show?id=992411149e' target=_blank style='color:#2F92EE;'>#2抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1114, encryptionId=992411149e, topicName=2抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Mon Dec 07 07:31:00 CST 2015, time=2015-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1851275, encodeId=241918512e540, content=<a href='/topic/show?id=f0a254918f0' target=_blank style='color:#2F92EE;'>#抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Sat Sep 10 01:31:00 CST 2016, time=2016-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793901, encodeId=bad01e93901f0, content=<a href='/topic/show?id=722516221ec' target=_blank style='color:#2F92EE;'>#SGLT-2抑制#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16221, encryptionId=722516221ec, topicName=SGLT-2抑制)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=052a130, createdName=yyj062, createdTime=Wed Apr 06 10:31:00 CST 2016, time=2016-04-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793772, encodeId=2bf41e9377282, content=<a href='/topic/show?id=5a3f1621e7d' target=_blank style='color:#2F92EE;'>#SGLT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16217, encryptionId=5a3f1621e7d, topicName=SGLT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Sun Dec 20 11:31:00 CST 2015, time=2015-12-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55396, encodeId=0da35539699, content=好药,值得推广!, beContent=null, objectType=article, channel=null, level=null, likeNumber=178, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 23:32:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55393, encodeId=328f55393f3, content=好,, beContent=null, objectType=article, channel=null, level=null, likeNumber=134, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 23:31:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55394, encodeId=37315539411, content=不错!, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 23:31:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55395, encodeId=8ef05539549, content=新药,, beContent=null, objectType=article, channel=null, level=null, likeNumber=172, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 23:31:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=49101, encodeId=6cf3491010f, content=好文章,值得收藏, beContent=null, objectType=article, channel=null, level=null, likeNumber=181, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bc301610909, createdName=hixiaoluo, createdTime=Sun Dec 27 09:05:00 CST 2015, time=2015-12-27, status=1, ipAttribution=)]
    2015-12-20 tulenzi
  6. [GetPortalCommentsPageByObjectIdResponse(id=2081963, encodeId=03842081963b3, content=<a href='/topic/show?id=acf116218e6' target=_blank style='color:#2F92EE;'>#SGLT-2#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16218, encryptionId=acf116218e6, topicName=SGLT-2)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0a3a2500014, createdName=fmq_28614553, createdTime=Wed Aug 31 00:31:00 CST 2016, time=2016-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1995474, encodeId=142319954e45c, content=<a href='/topic/show?id=992411149e' target=_blank style='color:#2F92EE;'>#2抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1114, encryptionId=992411149e, topicName=2抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Mon Dec 07 07:31:00 CST 2015, time=2015-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1851275, encodeId=241918512e540, content=<a href='/topic/show?id=f0a254918f0' target=_blank style='color:#2F92EE;'>#抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Sat Sep 10 01:31:00 CST 2016, time=2016-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793901, encodeId=bad01e93901f0, content=<a href='/topic/show?id=722516221ec' target=_blank style='color:#2F92EE;'>#SGLT-2抑制#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16221, encryptionId=722516221ec, topicName=SGLT-2抑制)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=052a130, createdName=yyj062, createdTime=Wed Apr 06 10:31:00 CST 2016, time=2016-04-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793772, encodeId=2bf41e9377282, content=<a href='/topic/show?id=5a3f1621e7d' target=_blank style='color:#2F92EE;'>#SGLT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16217, encryptionId=5a3f1621e7d, topicName=SGLT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Sun Dec 20 11:31:00 CST 2015, time=2015-12-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55396, encodeId=0da35539699, content=好药,值得推广!, beContent=null, objectType=article, channel=null, level=null, likeNumber=178, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 23:32:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55393, encodeId=328f55393f3, content=好,, beContent=null, objectType=article, channel=null, level=null, likeNumber=134, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 23:31:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55394, encodeId=37315539411, content=不错!, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 23:31:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55395, encodeId=8ef05539549, content=新药,, beContent=null, objectType=article, channel=null, level=null, likeNumber=172, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 23:31:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=49101, encodeId=6cf3491010f, content=好文章,值得收藏, beContent=null, objectType=article, channel=null, level=null, likeNumber=181, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bc301610909, createdName=hixiaoluo, createdTime=Sun Dec 27 09:05:00 CST 2015, time=2015-12-27, status=1, ipAttribution=)]
    2016-01-09 medsic

    好药,值得推广!

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=2081963, encodeId=03842081963b3, content=<a href='/topic/show?id=acf116218e6' target=_blank style='color:#2F92EE;'>#SGLT-2#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16218, encryptionId=acf116218e6, topicName=SGLT-2)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0a3a2500014, createdName=fmq_28614553, createdTime=Wed Aug 31 00:31:00 CST 2016, time=2016-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1995474, encodeId=142319954e45c, content=<a href='/topic/show?id=992411149e' target=_blank style='color:#2F92EE;'>#2抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1114, encryptionId=992411149e, topicName=2抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Mon Dec 07 07:31:00 CST 2015, time=2015-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1851275, encodeId=241918512e540, content=<a href='/topic/show?id=f0a254918f0' target=_blank style='color:#2F92EE;'>#抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Sat Sep 10 01:31:00 CST 2016, time=2016-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793901, encodeId=bad01e93901f0, content=<a href='/topic/show?id=722516221ec' target=_blank style='color:#2F92EE;'>#SGLT-2抑制#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16221, encryptionId=722516221ec, topicName=SGLT-2抑制)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=052a130, createdName=yyj062, createdTime=Wed Apr 06 10:31:00 CST 2016, time=2016-04-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793772, encodeId=2bf41e9377282, content=<a href='/topic/show?id=5a3f1621e7d' target=_blank style='color:#2F92EE;'>#SGLT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16217, encryptionId=5a3f1621e7d, topicName=SGLT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Sun Dec 20 11:31:00 CST 2015, time=2015-12-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55396, encodeId=0da35539699, content=好药,值得推广!, beContent=null, objectType=article, channel=null, level=null, likeNumber=178, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 23:32:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55393, encodeId=328f55393f3, content=好,, beContent=null, objectType=article, channel=null, level=null, likeNumber=134, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 23:31:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55394, encodeId=37315539411, content=不错!, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 23:31:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55395, encodeId=8ef05539549, content=新药,, beContent=null, objectType=article, channel=null, level=null, likeNumber=172, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 23:31:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=49101, encodeId=6cf3491010f, content=好文章,值得收藏, beContent=null, objectType=article, channel=null, level=null, likeNumber=181, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bc301610909, createdName=hixiaoluo, createdTime=Sun Dec 27 09:05:00 CST 2015, time=2015-12-27, status=1, ipAttribution=)]
    2016-01-09 medsic

    好,

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=2081963, encodeId=03842081963b3, content=<a href='/topic/show?id=acf116218e6' target=_blank style='color:#2F92EE;'>#SGLT-2#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16218, encryptionId=acf116218e6, topicName=SGLT-2)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0a3a2500014, createdName=fmq_28614553, createdTime=Wed Aug 31 00:31:00 CST 2016, time=2016-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1995474, encodeId=142319954e45c, content=<a href='/topic/show?id=992411149e' target=_blank style='color:#2F92EE;'>#2抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1114, encryptionId=992411149e, topicName=2抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Mon Dec 07 07:31:00 CST 2015, time=2015-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1851275, encodeId=241918512e540, content=<a href='/topic/show?id=f0a254918f0' target=_blank style='color:#2F92EE;'>#抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Sat Sep 10 01:31:00 CST 2016, time=2016-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793901, encodeId=bad01e93901f0, content=<a href='/topic/show?id=722516221ec' target=_blank style='color:#2F92EE;'>#SGLT-2抑制#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16221, encryptionId=722516221ec, topicName=SGLT-2抑制)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=052a130, createdName=yyj062, createdTime=Wed Apr 06 10:31:00 CST 2016, time=2016-04-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793772, encodeId=2bf41e9377282, content=<a href='/topic/show?id=5a3f1621e7d' target=_blank style='color:#2F92EE;'>#SGLT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16217, encryptionId=5a3f1621e7d, topicName=SGLT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Sun Dec 20 11:31:00 CST 2015, time=2015-12-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55396, encodeId=0da35539699, content=好药,值得推广!, beContent=null, objectType=article, channel=null, level=null, likeNumber=178, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 23:32:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55393, encodeId=328f55393f3, content=好,, beContent=null, objectType=article, channel=null, level=null, likeNumber=134, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 23:31:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55394, encodeId=37315539411, content=不错!, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 23:31:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55395, encodeId=8ef05539549, content=新药,, beContent=null, objectType=article, channel=null, level=null, likeNumber=172, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 23:31:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=49101, encodeId=6cf3491010f, content=好文章,值得收藏, beContent=null, objectType=article, channel=null, level=null, likeNumber=181, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bc301610909, createdName=hixiaoluo, createdTime=Sun Dec 27 09:05:00 CST 2015, time=2015-12-27, status=1, ipAttribution=)]
    2016-01-09 medsic

    不错!

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=2081963, encodeId=03842081963b3, content=<a href='/topic/show?id=acf116218e6' target=_blank style='color:#2F92EE;'>#SGLT-2#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16218, encryptionId=acf116218e6, topicName=SGLT-2)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0a3a2500014, createdName=fmq_28614553, createdTime=Wed Aug 31 00:31:00 CST 2016, time=2016-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1995474, encodeId=142319954e45c, content=<a href='/topic/show?id=992411149e' target=_blank style='color:#2F92EE;'>#2抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1114, encryptionId=992411149e, topicName=2抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Mon Dec 07 07:31:00 CST 2015, time=2015-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1851275, encodeId=241918512e540, content=<a href='/topic/show?id=f0a254918f0' target=_blank style='color:#2F92EE;'>#抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Sat Sep 10 01:31:00 CST 2016, time=2016-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793901, encodeId=bad01e93901f0, content=<a href='/topic/show?id=722516221ec' target=_blank style='color:#2F92EE;'>#SGLT-2抑制#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16221, encryptionId=722516221ec, topicName=SGLT-2抑制)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=052a130, createdName=yyj062, createdTime=Wed Apr 06 10:31:00 CST 2016, time=2016-04-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793772, encodeId=2bf41e9377282, content=<a href='/topic/show?id=5a3f1621e7d' target=_blank style='color:#2F92EE;'>#SGLT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16217, encryptionId=5a3f1621e7d, topicName=SGLT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Sun Dec 20 11:31:00 CST 2015, time=2015-12-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55396, encodeId=0da35539699, content=好药,值得推广!, beContent=null, objectType=article, channel=null, level=null, likeNumber=178, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 23:32:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55393, encodeId=328f55393f3, content=好,, beContent=null, objectType=article, channel=null, level=null, likeNumber=134, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 23:31:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55394, encodeId=37315539411, content=不错!, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 23:31:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55395, encodeId=8ef05539549, content=新药,, beContent=null, objectType=article, channel=null, level=null, likeNumber=172, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 23:31:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=49101, encodeId=6cf3491010f, content=好文章,值得收藏, beContent=null, objectType=article, channel=null, level=null, likeNumber=181, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bc301610909, createdName=hixiaoluo, createdTime=Sun Dec 27 09:05:00 CST 2015, time=2015-12-27, status=1, ipAttribution=)]
    2016-01-09 medsic

    新药,

    0

  10. [GetPortalCommentsPageByObjectIdResponse(id=2081963, encodeId=03842081963b3, content=<a href='/topic/show?id=acf116218e6' target=_blank style='color:#2F92EE;'>#SGLT-2#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16218, encryptionId=acf116218e6, topicName=SGLT-2)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0a3a2500014, createdName=fmq_28614553, createdTime=Wed Aug 31 00:31:00 CST 2016, time=2016-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1995474, encodeId=142319954e45c, content=<a href='/topic/show?id=992411149e' target=_blank style='color:#2F92EE;'>#2抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1114, encryptionId=992411149e, topicName=2抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Mon Dec 07 07:31:00 CST 2015, time=2015-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1851275, encodeId=241918512e540, content=<a href='/topic/show?id=f0a254918f0' target=_blank style='color:#2F92EE;'>#抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Sat Sep 10 01:31:00 CST 2016, time=2016-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793901, encodeId=bad01e93901f0, content=<a href='/topic/show?id=722516221ec' target=_blank style='color:#2F92EE;'>#SGLT-2抑制#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16221, encryptionId=722516221ec, topicName=SGLT-2抑制)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=052a130, createdName=yyj062, createdTime=Wed Apr 06 10:31:00 CST 2016, time=2016-04-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793772, encodeId=2bf41e9377282, content=<a href='/topic/show?id=5a3f1621e7d' target=_blank style='color:#2F92EE;'>#SGLT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16217, encryptionId=5a3f1621e7d, topicName=SGLT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Sun Dec 20 11:31:00 CST 2015, time=2015-12-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55396, encodeId=0da35539699, content=好药,值得推广!, beContent=null, objectType=article, channel=null, level=null, likeNumber=178, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 23:32:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55393, encodeId=328f55393f3, content=好,, beContent=null, objectType=article, channel=null, level=null, likeNumber=134, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 23:31:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55394, encodeId=37315539411, content=不错!, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 23:31:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=55395, encodeId=8ef05539549, content=新药,, beContent=null, objectType=article, channel=null, level=null, likeNumber=172, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32ba1611217, createdName=medsic, createdTime=Sat Jan 09 23:31:00 CST 2016, time=2016-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=49101, encodeId=6cf3491010f, content=好文章,值得收藏, beContent=null, objectType=article, channel=null, level=null, likeNumber=181, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bc301610909, createdName=hixiaoluo, createdTime=Sun Dec 27 09:05:00 CST 2015, time=2015-12-27, status=1, ipAttribution=)]
    2015-12-27 hixiaoluo

    好文章,值得收藏

    0

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郭艺芳:年龄界限与降压治疗目标值

近一年内,欧洲、美国、日本等多家国际权威学术机构相继更新了高血压防治指南。总的来看,这些指南有一个共同特点,就是不再强调对心血管高危人群(如冠心病、糖尿病、慢性肾病等)进行更为严格的血压控制。包括我国指南在内的多种指南均将年龄(分别为60岁、65岁、75岁、80岁)做为确定降压治疗目标值的主要依据,即推荐将较年轻的患者血压降低至<140/90mmHg,老年人或高龄老年人的血压控制目标较为宽松(