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降糖药SGLT-2抑制剂也能治心衰？看完本文马上掌握！

2021-07-22 MedSci原创 MedSci原创

急性心衰慢性心衰射血分数降低型心力衰竭
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血管紧张素受体-脑啡肽酶抑制剂(ARNI)、 SGLT-2抑制剂成为一线药物.

内容速览

  • 指南更新：
加拿大心血管学会（CCS）联合加拿大心衰学会（CHFS）于今年4月更新心衰指南；欧洲心脏病学学会（ESC）于近日召开的心力衰竭会议上更新了急性和慢性心力衰竭诊疗指南。关于射血分数降低型心衰（HFrEF）的治疗，指南中有两点更新值得特别关注：
1.  血管紧张素受体-脑啡肽酶抑制剂(ARNI)成为一线药物：无论患者是否使用过ACEI，都可以用ARNI。
2.  SGLT-2抑制剂成为一线药物：无论是否合并2型糖尿病（T2DM），都可使用SGLT2抑制剂，主要推荐达格列净、恩格列净。

 

  • 达格列净获批：
达格列净于2021年2月4日在中国正式获批，成为中国首个获批心衰适应症的SGLT2抑制剂，适应症为成人射血分数降低型心衰（HFrEF，NYHA II-IV级）。
一般我们提到心衰，即指慢性心衰，需长期用药治疗，同时密切监测以根据患者实际情况调整。2016年ESC指南将慢性心衰根据射血分数分为3类：射血分数降低型心衰（HFrEF）、射血分数处于中间范围的心衰（HFmrEF）和射血分数保留型心衰（HFpEF），其对应的左室射血分数（LVEF）范围分别为<40%，40％-49％和≥50%。其中射血分数降低型心衰（HFrEF）即收缩性心力衰竭，是指心脏收缩功能不全时，左室射血分数下降。HFrEF是所有心衰中最常见、也是临床数据最多、指南更新最快的心衰。
 
 
一、指南怎么说
 
随着对收缩性心力衰竭的深入研究，指南也不断更新。以往，国内外的旧版指南一线用药包括三种：ACEI/ARB/ARNI、β受体阻滞剂、盐皮质激素受体拮抗剂。但在今年，无论是加拿大心血管学会（CCS）和加拿大心衰学会（CHFS），还是欧洲心脏病学学会（ESC），都将血管紧张素受体-脑啡肽酶抑制剂（ARNI）和钠-葡萄糖协同转运蛋白2（SGLT-2）抑制剂推荐为一线用药。并且值得注意的是，指南明确表示：心衰患者无论是否合并糖尿病，都推荐使用SGLT-2抑制剂为一线用药。
 
由于达格列净和恩格列净有充足实验数据（尤其是有未合并糖尿病的患者数据）证明其可以降低心衰死亡或住院风险，因此目前指南主要推荐达格列净、恩格列净作为心衰的一线用药。
图片
图源：Can J Cardiol
 
二、证据在哪里
 
1、达格列净（dapagliflozin）—— “DAPA-HF Trial”
 
DAPA-HF III期临床试验于2019年完成并公布数据，本试验中共入组4744名受试者，入组要求射血分数<40%。试验采取随机分组的方式，将患者分为“达格列净（10mg/d）+传统治疗组”和“安慰剂+传统治疗组”。结果表明，达格列净组患者的心衰恶化率（定义为心衰恶化导致患者需住院或心衰恶化需要静脉给药）相比于安慰剂组降低4.9%（16.3%vs 21.2%，p<0.001），这一结论与患者是否同时伴有糖尿病无关。
 
图片
图源：N Engl J Med
 
基于DAPA-HF III期临床试验，达格列净（安达唐，阿斯利康中国）于今年2月4日在中国正式获批，用于成人射血分数降低型心衰（HFrEF，NYHAII-IV级）的治疗，可降低心血管死亡、心衰恶化住院的风险，成为中国首个获批心衰适应症的SGLT2抑制剂。
 
2、恩格列净（empagliflozin）-- EMPEROR-Reduced Trial
 
EMPEROR-Reduced 临床试验于2020年完成并公布结果，该试验为双盲随机试验，共纳入3730名射血分数<40%的慢性心衰患者，并将其随机分两组，分别为“达格列净（10mg/d）+传统治疗组”和“安慰剂+传统治疗组”。结果表明，达格列净组的患者心血管疾病死亡率和心衰恶化导致患者住院率相比于对照组低5.3%（19.4%vs 24.7%，p<0.001），且该结果与患者是否同时患有糖尿病无关。
 
图片
图源：Circulation
 
除此以外，EMPA-REG OUTCOME、CANVAS-R、DECLARE-TIMI 58、CREDENCE等实验也都证实了SGLT-2抑制剂可以降低心衰住院率或死亡率。
 
图片
图源：Can J Cardiol.
 
 
三、达格列净怎么用
 
如前文所说，达格列净是首个在中国获批心衰适应症的SGLT2抑制剂，适用于成人射血分数降低型心衰（HFrEF，NYHAII-IV级）。当用于心衰时，其起始剂量和目标剂量均为10mg每日一次（需要注意的是，达格列净用于心力衰竭的起始剂量与用于2型糖尿病时不同，用于2型糖尿病时起始剂量为5mg每日一次，可根据患者情况增加至10mg每日一次）。
图片
尽管达格列净在心衰治疗指南中成为一线用药，但是“是药就有不良反应”，临床上对于达格列净可能发生的不良反应的处理十分重要。让我们用个表格来总结一下常见以及严重不良反应及其处理吧：
 
图片
参考文献：
1.    McMurray JJV, Solomon SD, Inzucchi SE, et al.Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N EnglJ Med. 2019;381(21):1995-2008. doi:10.1056/NEJMoa1911303
2.    Anker SD, Butler J, Filippatos G, et al. Effectof Empagliflozin on Cardiovascular and Renal Outcomes in Patients With HeartFailure by Baseline Diabetes Status: Results From the EMPEROR-Reduced Trial. Circulation.2021;143(4):337-349. doi:10.1161/CIRCULATIONAHA.120.051824
3.    McDonald M, Virani S, Chan M, et al. CCS/CHFSHeart Failure Guidelines Update: Defining a New Pharmacologic Standard of Carefor Heart Failure With Reduced Ejection Fraction. Can JCardiol. 2021;37(4):531-546. doi:10.1016/j.cjca.2021.01.017
4.    O'Meara E, McDonald M, Chan M, et al. CCS/CHFSHeart Failure Guidelines: Clinical Trial Update on Functional MitralRegurgitation, SGLT2 Inhibitors, ARNI in HFpEF, and Tafamidis in Amyloidosis. Can JCardiol. 2020;36(2):159-169. doi:10.1016/j.cjca.2019.11.036
5.    ESC-HF 2021 presentations and guidelineupdates.
6.    达格列净药品说明书
7.    Dapagliiflozin. In: Lexi-drugs online [databaseon the Internet]. Hudson (OH): Lexicomp, Inc.; 2021 [updated 12 Jul 2021; cited17 Jul 2021]. Available from: http://online.lexi.com. Subscription required toview.

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1995637, encodeId=07ae199563efb, 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=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1114, encryptionId=992411149e, topicName=2抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28b7142, createdName=liuquan, createdTime=Sat Jan 01 22:59:32 CST 2022, time=2022-01-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1852713, encodeId=e5761852e133b, 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=33, 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=Thu Mar 03 15:59:32 CST 2022, time=2022-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793859, encodeId=06721e938598b, content=<a href='/topic/show?id=5a3f1621e7d' target=_blank style='color:#2F92EE;'>#SGLT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16217, encryptionId=5a3f1621e7d, topicName=SGLT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Fri Jan 14 14:59:32 CST 2022, time=2022-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793916, encodeId=793b1e939162b, 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=35, 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=Tue Oct 26 14:59:32 CST 2021, time=2021-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2081986, encodeId=45d5208198643, content=<a href='/topic/show?id=acf116218e6' target=_blank style='color:#2F92EE;'>#SGLT-2#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, 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 Dec 15 03:59:32 CST 2021, time=2021-12-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1006666, encodeId=631610066667a, content=超级点赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLyXfB3bOYOsDt885AsrYWhiaRtRdPh9aZlXugm7XErBVXusv5fJLIKWTicmjSQcOibDiaLzE2YMD44PA/132, createdBy=49f71976501, createdName=Doctoryangbai, createdTime=Tue Aug 10 16:24:35 CST 2021, time=2021-08-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1270928, encodeId=41ac12e092867, content=<a href='/topic/show?id=4066981e99e' target=_blank style='color:#2F92EE;'>#降糖药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98179, encryptionId=4066981e99e, topicName=降糖药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Sat Jul 24 00:59:32 CST 2021, time=2021-07-24, status=1, ipAttribution=)]
    2022-01-01 liuquan

    #2抑制剂#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1995637, encodeId=07ae199563efb, 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=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1114, encryptionId=992411149e, topicName=2抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28b7142, createdName=liuquan, createdTime=Sat Jan 01 22:59:32 CST 2022, time=2022-01-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1852713, encodeId=e5761852e133b, 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=33, 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=Thu Mar 03 15:59:32 CST 2022, time=2022-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793859, encodeId=06721e938598b, content=<a href='/topic/show?id=5a3f1621e7d' target=_blank style='color:#2F92EE;'>#SGLT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16217, encryptionId=5a3f1621e7d, topicName=SGLT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Fri Jan 14 14:59:32 CST 2022, time=2022-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793916, encodeId=793b1e939162b, 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=35, 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=Tue Oct 26 14:59:32 CST 2021, time=2021-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2081986, encodeId=45d5208198643, content=<a href='/topic/show?id=acf116218e6' target=_blank style='color:#2F92EE;'>#SGLT-2#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, 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 Dec 15 03:59:32 CST 2021, time=2021-12-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1006666, encodeId=631610066667a, content=超级点赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLyXfB3bOYOsDt885AsrYWhiaRtRdPh9aZlXugm7XErBVXusv5fJLIKWTicmjSQcOibDiaLzE2YMD44PA/132, createdBy=49f71976501, createdName=Doctoryangbai, createdTime=Tue Aug 10 16:24:35 CST 2021, time=2021-08-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1270928, encodeId=41ac12e092867, content=<a href='/topic/show?id=4066981e99e' target=_blank style='color:#2F92EE;'>#降糖药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98179, encryptionId=4066981e99e, topicName=降糖药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Sat Jul 24 00:59:32 CST 2021, time=2021-07-24, status=1, ipAttribution=)]
    2022-03-03 jklm09

    #抑制剂#

    0

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    2022-01-14 tulenzi

    #SGLT#

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1995637, encodeId=07ae199563efb, 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=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1114, encryptionId=992411149e, topicName=2抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28b7142, createdName=liuquan, createdTime=Sat Jan 01 22:59:32 CST 2022, time=2022-01-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1852713, encodeId=e5761852e133b, 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=33, 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=Thu Mar 03 15:59:32 CST 2022, time=2022-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793859, encodeId=06721e938598b, content=<a href='/topic/show?id=5a3f1621e7d' target=_blank style='color:#2F92EE;'>#SGLT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16217, encryptionId=5a3f1621e7d, topicName=SGLT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Fri Jan 14 14:59:32 CST 2022, time=2022-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793916, encodeId=793b1e939162b, 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=35, 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=Tue Oct 26 14:59:32 CST 2021, time=2021-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2081986, encodeId=45d5208198643, content=<a href='/topic/show?id=acf116218e6' target=_blank style='color:#2F92EE;'>#SGLT-2#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, 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 Dec 15 03:59:32 CST 2021, time=2021-12-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1006666, encodeId=631610066667a, content=超级点赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLyXfB3bOYOsDt885AsrYWhiaRtRdPh9aZlXugm7XErBVXusv5fJLIKWTicmjSQcOibDiaLzE2YMD44PA/132, createdBy=49f71976501, createdName=Doctoryangbai, createdTime=Tue Aug 10 16:24:35 CST 2021, time=2021-08-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1270928, encodeId=41ac12e092867, content=<a href='/topic/show?id=4066981e99e' target=_blank style='color:#2F92EE;'>#降糖药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98179, encryptionId=4066981e99e, topicName=降糖药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Sat Jul 24 00:59:32 CST 2021, time=2021-07-24, status=1, ipAttribution=)]
    2021-10-26 yyj062

    #SGLT-2抑制#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1995637, encodeId=07ae199563efb, 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=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1114, encryptionId=992411149e, topicName=2抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28b7142, createdName=liuquan, createdTime=Sat Jan 01 22:59:32 CST 2022, time=2022-01-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1852713, encodeId=e5761852e133b, 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=33, 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=Thu Mar 03 15:59:32 CST 2022, time=2022-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793859, encodeId=06721e938598b, content=<a href='/topic/show?id=5a3f1621e7d' target=_blank style='color:#2F92EE;'>#SGLT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16217, encryptionId=5a3f1621e7d, topicName=SGLT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Fri Jan 14 14:59:32 CST 2022, time=2022-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793916, encodeId=793b1e939162b, 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=35, 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=Tue Oct 26 14:59:32 CST 2021, time=2021-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2081986, encodeId=45d5208198643, content=<a href='/topic/show?id=acf116218e6' target=_blank style='color:#2F92EE;'>#SGLT-2#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, 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 Dec 15 03:59:32 CST 2021, time=2021-12-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1006666, encodeId=631610066667a, content=超级点赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLyXfB3bOYOsDt885AsrYWhiaRtRdPh9aZlXugm7XErBVXusv5fJLIKWTicmjSQcOibDiaLzE2YMD44PA/132, createdBy=49f71976501, createdName=Doctoryangbai, createdTime=Tue Aug 10 16:24:35 CST 2021, time=2021-08-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1270928, encodeId=41ac12e092867, content=<a href='/topic/show?id=4066981e99e' target=_blank style='color:#2F92EE;'>#降糖药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98179, encryptionId=4066981e99e, topicName=降糖药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Sat Jul 24 00:59:32 CST 2021, time=2021-07-24, status=1, ipAttribution=)]
    2021-12-15 fmq_28614553

    #SGLT-2#

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1995637, encodeId=07ae199563efb, 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=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1114, encryptionId=992411149e, topicName=2抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28b7142, createdName=liuquan, createdTime=Sat Jan 01 22:59:32 CST 2022, time=2022-01-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1852713, encodeId=e5761852e133b, 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=33, 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=Thu Mar 03 15:59:32 CST 2022, time=2022-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793859, encodeId=06721e938598b, content=<a href='/topic/show?id=5a3f1621e7d' target=_blank style='color:#2F92EE;'>#SGLT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16217, encryptionId=5a3f1621e7d, topicName=SGLT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Fri Jan 14 14:59:32 CST 2022, time=2022-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793916, encodeId=793b1e939162b, 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=35, 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=Tue Oct 26 14:59:32 CST 2021, time=2021-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2081986, encodeId=45d5208198643, content=<a href='/topic/show?id=acf116218e6' target=_blank style='color:#2F92EE;'>#SGLT-2#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, 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 Dec 15 03:59:32 CST 2021, time=2021-12-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1006666, encodeId=631610066667a, content=超级点赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLyXfB3bOYOsDt885AsrYWhiaRtRdPh9aZlXugm7XErBVXusv5fJLIKWTicmjSQcOibDiaLzE2YMD44PA/132, createdBy=49f71976501, createdName=Doctoryangbai, createdTime=Tue Aug 10 16:24:35 CST 2021, time=2021-08-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1270928, encodeId=41ac12e092867, content=<a href='/topic/show?id=4066981e99e' target=_blank style='color:#2F92EE;'>#降糖药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98179, encryptionId=4066981e99e, topicName=降糖药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Sat Jul 24 00:59:32 CST 2021, time=2021-07-24, status=1, ipAttribution=)]
    2021-08-10 Doctoryangbai

    超级点赞

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1995637, encodeId=07ae199563efb, 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=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1114, encryptionId=992411149e, topicName=2抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28b7142, createdName=liuquan, createdTime=Sat Jan 01 22:59:32 CST 2022, time=2022-01-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1852713, encodeId=e5761852e133b, 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=33, 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=Thu Mar 03 15:59:32 CST 2022, time=2022-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793859, encodeId=06721e938598b, content=<a href='/topic/show?id=5a3f1621e7d' target=_blank style='color:#2F92EE;'>#SGLT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16217, encryptionId=5a3f1621e7d, topicName=SGLT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Fri Jan 14 14:59:32 CST 2022, time=2022-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793916, encodeId=793b1e939162b, 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=35, 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=Tue Oct 26 14:59:32 CST 2021, time=2021-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2081986, encodeId=45d5208198643, content=<a href='/topic/show?id=acf116218e6' target=_blank style='color:#2F92EE;'>#SGLT-2#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, 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 Dec 15 03:59:32 CST 2021, time=2021-12-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1006666, encodeId=631610066667a, content=超级点赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLyXfB3bOYOsDt885AsrYWhiaRtRdPh9aZlXugm7XErBVXusv5fJLIKWTicmjSQcOibDiaLzE2YMD44PA/132, createdBy=49f71976501, createdName=Doctoryangbai, createdTime=Tue Aug 10 16:24:35 CST 2021, time=2021-08-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1270928, encodeId=41ac12e092867, content=<a href='/topic/show?id=4066981e99e' target=_blank style='color:#2F92EE;'>#降糖药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98179, encryptionId=4066981e99e, topicName=降糖药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Sat Jul 24 00:59:32 CST 2021, time=2021-07-24, status=1, ipAttribution=)]
    2021-07-24 minlingfeng

    #降糖药#

    0

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