Nat Med:新冠病毒感染康复后产生的抗体或只能维持2到3个月,或将演变成季节性流感

2020-06-20 MedSci MedSci原创

新冠病毒感染后,患者免疫强度和持续时间是非常重要的问题,也是决定如何以及何时放松社交疏离政策的关键。先前的研究表明,SARS-CoV、MERS-CoV的抗体至少持续1年。在SARS-CoV感染后,持续

梅斯医学小编:

新冠病毒感染后有几种可能的结局。其一,就象麻疹等一样,感染一次,终身免疫,因为产生的抗体能持续一辈子;其二,象流感一样,感染一次,也产生抗体,但持续时间很短。因此,一年之内,尤其是秋冬季节,容易不断感染流感。同时,加上病毒不断突变,流感有N多亚型。从目前的有限证据来看,新冠病毒感染很可能类似“大流感”,一次感染能维持2-3个月,意味着,一个季节可能会感染一次,加上未来可能也会突变成不同的亚型,混合感染。那么,人类即使有疫苗(疫苗不大可能人人接种),新冠病毒感染仍然比较流行,人类将与新冠病毒持续斗争下去。这种概率越来越突出了,极有可能演变为类似季节性流感的样子。

以下是最新的一篇研究

新冠病毒感染后,患者免疫强度和持续时间是非常重要的问题,也是决定如何以及何时放松社交疏离政策的关键。先前的研究表明,SARS-CoV、MERS-CoV的抗体至少持续1年。在SARS-CoV感染后,持续维持IgG抗体水平超过2年。实验室确认的MERS-CoV感染个体的抗体反应在疫情暴发后至少持续了34个月。但来自中国的最新研究发现,SARS-CoV-2感染后的恢复患者尤其是无症状患者的IgG抗体水平和中和抗体在感染后2-3个月内开始大比例下降。

事实上,这项研究与刚刚在预印本上发表的另一篇文章很相似。根据伦敦大学圣乔治学院的一项新研究,在成功战胜新冠病毒的人中,只有不到10%的人没有产生抵御第二次感染所需的保护性抗体。这项研究涉及177名新冠肺炎患者,在他们战胜病毒后的几周内,科学家们专门研究他们体内的蛋白质。伦敦大学圣乔治学院的科学家们发现,8.5%的人在初次感染康复后没有产生能够保护他们免受新冠病毒再次感染的抗体。早前的研究和统计显示,在美国,与白人患者相比,少数族裔更容易遭受严重的新冠病毒感染;而伦敦大学圣乔治学院的研究显示,非白人患者的抗体数较高。

有关新冠病毒抗体不能持续太久的结论,来自6月19日刊发于国际权威医学期刊《自然-医学》(Nature Medicine)的研究,研究团队来自重庆医科大学黄爱龙、陈娟、邱景富等。

大多数感染SARS-CoV-2的患者都有轻微至严重的呼吸系统疾病,症状包括发烧、咳嗽和呼吸短促,可能在接触后2-14天出现。然而,还有一些患者核酸检测阳性、但无症状或症状轻微。

越来越多的证据表明,无症状个体也可以传播病毒,而这些隐匿的SARS-CoV-2传播者的出现,给控制疫情带来了困难。然而,研究者对无症状的SARS-CoV-2感染个体的临床特征和免疫反应的了解是有限的。在这项研究中,研究者描述了37例无症状患者的流行病学特征、临床特征、病毒水平和免疫反应。

人口统计学特征

国家卫生健康委2月6日印发《新型冠状病毒肺炎防控方案(第四版)》,随后,重庆市万州区疾控中心对2088名检疫密切接触者进行了广泛的核酸筛查。根据当地疾控中心的记录,其中60人在14天内没有出现症状,并被转移到政府指定的医院进行集中隔离。

SARS-CoV-2感染者的临床特征和免疫反应尚不清楚。重庆医科大学团队研究了重庆市万州区37例SARS-CoV-2核酸检测阳性但在前14天和住院期间无相关临床症状的无症状患者。无症状患者按照政策指定的重庆市万州区人民医院集中隔离。

入院时,根据临床医生报告的症状评估,17名患者因轻度或非典型症状被排除;入院后4-17天出现症状的6名患者也被排除在外,最后,37例无症状患者纳入本研究。

无症状患者为在住院14天及住院期间核酸检测阳性,无相关临床症状的个体。根据疾控中心监测系统的跟踪,2020年4月10日之前,重庆市万州区共发现178例确诊的SARS-CoV-2感染者。在本研究中,无症状感染者的比例为20.8%(37/178)。

在抗体检测和细胞因子检测中,研究者选取性别、年龄、共病匹配的轻度症状患者37例与无症状个体进行比较。同时选取万州区RT-PCR结果阴性的37例性别、年龄-频率匹配的对照组进行细胞因子比较。

37例无症状患者中,年龄中位数为41岁(范围8-75岁),22例为女性。28人与确诊的COVID-19患者有过接触史,其中9人为武汉居民或在发病前曾到武汉旅游。

放射学和实验室检查结果

患者在入院时进行了全血细胞计数、血液生化、凝血功能、肝肾功能和感染生物标志物的测定,监测潜在疾病进展情况。37例无症状患者中,3例为淋巴细胞减少,1例为血小板减少。6例患者丙氨酸转氨酶水平升高,11例患者c反应蛋白水平升高。

入院时,胸部CT显示11例无症状患者(11/37,29.7%)有局灶毛玻璃影像,10例患者(10/37,27.0%)有条影和/或弥漫性实变,而16例患者(16/37,43.2%)无异常。

在入院5天内,5例患者胸部CT显示有局灶毛玻璃影或条影。所有无症状者均未见胸腔积液、支气管充气征或淋巴结肿大,这些都是症状严重患者的典型改变。在无症状患者中,有66.7%(14/21)发现单肺异常,而33.3%(7/21)双肺异常。

病毒学结果

研究者比较了37名无症状患者和37名有症状患者的首个阳性鼻咽拭子的RT-PCR值(Ct)。37例无症状患者和37例有症状的者初始Ct值是相似的:无症状者ORF1b片段Ct值为32.8 (IQR, 30.9-35.8), 有症状者为31.7 (IQR, 30.3-35.1), P = 0.336;无症状者N片段Ct值为32.6 (IQR, 29.5-34.6),有症状者为33.5 (IQR, 31.3-37.2), P = 0.126。

排毒时间上,无症状者比有症状者更长。排毒时间的定义为从第一个阳性鼻咽拭子到最后一个阳性鼻咽拭子的间隔。无症状患者的排毒时间中位数为19天 (IQR 15-26天)。排毒时间最短为6天 ,最长45天。有轻度症状的感染者排毒中位时间为14天 (IQR 9-22天)。无症状组的排毒时间明显长于症状组。

不过,研究者指出,可测量的排毒时间并不等同于病毒具有传染性的时间,还需要进一步做病毒培养以进行评估。

无症状患者病毒特异性IgG和IgM水平

为了调查SARS-CoV-2感染的急性抗体反应,研究者对无症状和有症状感染者血清样本中的病毒特异性IgG和IgM进行了检查。

在无症状组有81.1% (30/37)IgG呈阳性,症状组在暴露约3-4周后有83.8%的IgG呈阳性 (31/37)。无症状组IgM阳性率为62.2%(23/37),症状组IgM阳性率为78.4%(29/37)。

无症状组的排毒中位时间为19天(IQR,15天-26天),明显长于有症状组(P=0.028)。无症状组的新冠病毒特异性抗体IgG水平(S/CO中位数为3.4; IQR,1.6-10.7)明显低于症状组在急性期的IgG水平(S/CO中位数为20.5; IQR, 5.8-38.2)。在无症状患者中,在恢复期早期IgG和中和抗体水平分别下降了93.3%(28/30)和81.1%(30/37),而在有症状的患者中则分别下降了96.8%(30/31)和62.2%(23/37)。40%的无症状个体血清阴性,12.9%的症状组在早期恢复期IgG呈阴性。此外,无症状个体18种促炎和抗炎细胞因子表现出较低的水平。

这些数据表明,无症状感染者免疫反应更弱。早期恢复期IgG和中和抗体水平的降低可能对免疫策略和血清学调查有意义。

研究者对37名无症状患者和37名有症状患者的早期恢复期(出院8周后)进行了随访。在恢复期早期,症状组IgG水平仍明显高于无症状组(P = 0.002)。令人惊讶的是,无症状组的93.3%(28/30)和症状组的96.8%(30/31)的IgG抗体水平在恢复期早期下降。无症状组IgG抗体水平下降的中位百分比为71.1%(范围32.8-88.8%),而症状组IgG水平下降的中位百分比为76.2%(范围10.9-96.2%)。

利用假病毒中和试验,研究者还观察到在无症状组的中和血清抗体水平下降了81.1%(30/37),在有症状组的中和血清抗体水平下降了62.2%(23/37)。无症状组的中和血清抗体的中位百分比下降为8.3%(范围为0.5-22.8%),而症状组中位百分比下降为11.7%(范围为2.3-41.1%)。此外,40.0%(12/30)无症状患者IgG呈血清阴性,只有12.9%(4/31)有症状患者IgG呈血清阴性。

无症状患者的细胞因子水平

为了进一步阐明与新冠病毒感染相关的免疫反应,研究人员比较了无症状组合有症状组之间的血清细胞因子和趋化因子水平。与无症状组相比,有症状组中观察到18种促炎和抗炎细胞因子的浓度升高。

与无症状组相比,症状组中18种促炎和抗炎细胞因子的浓度升高。此外,进一步分析无症状组和健康对照组的细胞因子。32种细胞因子的血浆水平在健康对照组和无症状个体之间是相似的。但无症状组能发现更高水平的干细胞因子(SCF) (P =1.48×109), IL-13 (P = 3.75×107)、白介素p40 (P = 7.08×106)和白血病抑制因子(生活)(P = 1.33×103)。总的来说,数据表明,无症状患者炎症反应较轻。

讨论

SARS-CoV-2的无症状感染者的临床特征和免疫反应尚未得到很好的描述。在178例实验室确诊的感染者中,37例在整个病程中从未出现任何症状。数据显示20.8%的患者有无症状感染。然而,这可能不是对一般人群无症状感染比例的准确估计,因为无症状感染者是由高风险感染人群(包括有去过武汉的密切接触者和个人)确定的,而不是随机抽样的人。因此,需要通过人群筛查确定无症状感染的比例。

此外,无症状感染的比例可能更高,因为有些病例可能被RT-PCR检测遗漏。通过抗体检测,研究者从148例RT-PCR阴性、无症状的病例中成功鉴定出7例SARS-CoV-2感染者。因此,及时RT-PCR与血清学检测相结合,有利于准确估计无症状比例。

然而,血清学检测有其局限性,检测的特异性和敏感性各不相同。研究结果也可能被先前存在的抗SARS-CoV、MERS-CoV或普通感冒冠状病毒的抗体所混淆。

到目前为止,SARS-CoV-2的RNA脱落时间尚未被很好地描述。在SARS-CoV中,超过30%的患者在发病后4周其咽喉拭子、粪便和尿液中均可检测到病毒RNA。在MERS-CoV感染中,呼吸道分泌物中的排毒至少持续3周。

一项研究报告称新冠病毒感染者的排毒平均持续时间是20 天(范围8天-37天)。另一份新加坡研究则报告,排毒时间至少为24 天。本研究中37例轻度症状患者排毒的中位持续时间为14天,较此前的研究相对较短。与有症状患者相比,无症状组排毒时间显著增长,达到19天。

值得注意的是,检测到病毒RNA并不一定意味着呼吸道标本中存在具有感染性病毒,因此基于RT-PCR计算的排毒时间来评估感染潜力要格外谨慎。

感染后的免疫强度和持续时间是非常关键的问题,也是决定如何以及何时放松社交疏离政策的关键。先前的研究表明,抗SARS-CoV或MERS-CoV的循环抗体至少持续1年。在SARS-CoV感染后,持续维持IgG抗体水平超过2年。实验室确认的MERS-CoV感染个体的抗体反应在疫情暴发后至少持续了34个月。

最近,针对SARS-CoV-2感染的适应性免疫反应的几项研究报道,大多数COVID-19恢复期患者具有可检测到的中和抗体,这与病毒特异性T细胞的数量相关。在本研究中可观察到,在SARS-CoV-2感染后中康复的个体中,有很大比例的IgG和中和抗体水平在感染后2至3个月内开始下降在另一项针对8名新冠肺炎康复期患者的中和抗体滴度动态分析显示,4名患者在发病后约7周显示中和抗体减少一种数学模型还表明新冠病毒感染后免疫力的持续时间较短。

尽管这些研究规模很小,但研究人员指出,上述这些发现可能会促使一些国家领导人重新考虑发放所谓的“免疫护照”。此前,一些国家已经在考虑向有抗新冠肺炎抗体的人发放免疫护照或无风险证书,使他们能在免受再次感染的前提下旅行或返回工作岗位。

科学家们表示,他们仍在研究新冠病毒的关键方面,包括一旦人体接触该病毒,免疫系统将如何做出反应。研究人员说,答案可能对疫苗的开发具有重大影响,包括它能以多快的速度向公众推广。

美国国家过敏和传染病研究所所长安东尼·福奇博士本月早些时候说,如果新冠病毒表现像其他冠状病毒一样,疫苗可能无法提供长期免疫。他在6月2日接受《美国医学会杂志》编辑霍华德·鲍希纳采访时表示:“纵观冠状病毒的历史,文献报告显示,常见的冠状病毒抗体的免疫持久性通常从三到六个月不等,一般都不到一年。” 科学家们面临的一个关键问题是,针对新冠病毒产生的抗体是否能防止再次感染。此外,研究人员仍然不确定如果抗体确实提供保护,免疫力能维持多久。

这些数据可能表明使用COVID-19“群体免疫”政策存在风险,并支持延长公共卫生干预措施,包括社交距离、卫生、隔离高危人群和广泛检测。研究者称,目前迫切需要更多的纵向血清学研究来分析更多的有症状和无症状个体,以确定抗体介导免疫的持续时间。此外,无症状患者抗病毒IgG水平低,可能更有可能成为血清阴性,这进一步支持需要及时进行血清调查,以研究真实感染率。

原始出处:

Long, Q., Tang, X., Shi, Q. et al. Clinical and immunological assessment of asymptomatic SARS-CoV-2 infections. Nat Med (2020). http://sci-hub.tw/10.1038/s41591-020-0965-6

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attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cf986929326, createdName=30397606, createdTime=Mon Jun 22 09:55:32 CST 2020, time=2020-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1533428, encodeId=a98f1533428bb, content=<a href='/topic/show?id=fe21454096b' target=_blank style='color:#2F92EE;'>#季节性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45409, encryptionId=fe21454096b, topicName=季节性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e4bd12435949, createdName=charleshjw, createdTime=Mon Jun 22 09:55:32 CST 2020, time=2020-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1591033, encodeId=b8b41591033aa, content=<a href='/topic/show?id=fe4a4541460' target=_blank style='color:#2F92EE;'>#季节性流感#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45414, encryptionId=fe4a4541460, topicName=季节性流感)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4d9717894537, createdName=sjzlzc013, createdTime=Mon Jun 22 09:55:32 CST 2020, time=2020-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1610538, encodeId=9cee1610538ec, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Mon Jun 22 09:55:32 CST 2020, time=2020-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1028211, encodeId=e5d2102821187, content=新冠肺炎,疫情何时才能消失, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=公卫新人, createdTime=Sat Jun 20 21:55:32 CST 2020, time=2020-06-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=799283, encodeId=0ed4e9928363, content=新冠肺炎的疫苗,即使成功,也很难完全杜绝病毒。, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sat Jun 20 19:58:35 CST 2020, time=2020-06-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=799282, encodeId=7536e992825c, content=<a href='/topic/show?id=46ce580e865' target=_blank style='color:#2F92EE;'>#新冠肺炎#</a>情况仍然令人担忧🐴🐴🐝🐝, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58078, encryptionId=46ce580e865, topicName=新冠肺炎)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sat Jun 20 19:58:11 CST 2020, time=2020-06-20, status=1, ipAttribution=)]
    2021-02-09 oliver181
  2. 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style='color:#2F92EE;'>#新冠肺炎#</a>情况仍然令人担忧🐴🐴🐝🐝, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58078, encryptionId=46ce580e865, topicName=新冠肺炎)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sat Jun 20 19:58:11 CST 2020, time=2020-06-20, status=1, ipAttribution=)]
    2020-12-19 liye789132251
  3. 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replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45414, encryptionId=fe4a4541460, topicName=季节性流感)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4d9717894537, createdName=sjzlzc013, createdTime=Mon Jun 22 09:55:32 CST 2020, time=2020-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1610538, encodeId=9cee1610538ec, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Mon Jun 22 09:55:32 CST 2020, time=2020-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1028211, encodeId=e5d2102821187, content=新冠肺炎,疫情何时才能消失, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=公卫新人, createdTime=Sat Jun 20 21:55:32 CST 2020, time=2020-06-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=799283, encodeId=0ed4e9928363, content=新冠肺炎的疫苗,即使成功,也很难完全杜绝病毒。, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sat Jun 20 19:58:35 CST 2020, time=2020-06-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=799282, encodeId=7536e992825c, content=<a href='/topic/show?id=46ce580e865' target=_blank style='color:#2F92EE;'>#新冠肺炎#</a>情况仍然令人担忧🐴🐴🐝🐝, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58078, encryptionId=46ce580e865, topicName=新冠肺炎)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sat Jun 20 19:58:11 CST 2020, time=2020-06-20, status=1, ipAttribution=)]
    2020-08-12 ms5000001417824766

    恐怖

    0

  4. 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    2020-06-22 30397606
  5. 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  6. 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  7. 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  8. 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createdName=liye789132251, createdTime=Sat Dec 19 09:55:32 CST 2020, time=2020-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=808233, encodeId=5458808233f9, content=恐怖, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200620/aa639dfc8a1a4edf8fd1a054e00988dd/d30946ee96694a4f8aa034f2e536c052.jpg, createdBy=23f62697515, createdName=ms5000001417824766, createdTime=Wed Aug 12 17:18:19 CST 2020, time=2020-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1468727, encodeId=e5341468e27c6, content=<a href='/topic/show?id=a19b4540688' target=_blank style='color:#2F92EE;'>#季节#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45406, encryptionId=a19b4540688, topicName=季节)], 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objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=公卫新人, createdTime=Sat Jun 20 21:55:32 CST 2020, time=2020-06-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=799283, encodeId=0ed4e9928363, content=新冠肺炎的疫苗,即使成功,也很难完全杜绝病毒。, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sat Jun 20 19:58:35 CST 2020, time=2020-06-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=799282, encodeId=7536e992825c, content=<a href='/topic/show?id=46ce580e865' target=_blank style='color:#2F92EE;'>#新冠肺炎#</a>情况仍然令人担忧🐴🐴🐝🐝, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58078, encryptionId=46ce580e865, topicName=新冠肺炎)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sat Jun 20 19:58:11 CST 2020, time=2020-06-20, status=1, ipAttribution=)]
    2020-06-20 公卫新人

    新冠肺炎,疫情何时才能消失

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=1745864, encodeId=0a211e458645a, content=<a href='/topic/show?id=34a5666451b' target=_blank style='color:#2F92EE;'>#演变#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66645, encryptionId=34a5666451b, topicName=演变)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=96a135615295, createdName=oliver181, createdTime=Tue Feb 09 21:55:32 CST 2021, time=2021-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1884402, encodeId=044d188440213, content=<a href='/topic/show?id=3b2112532d8' target=_blank style='color:#2F92EE;'>#Nat#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12532, encryptionId=3b2112532d8, topicName=Nat)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e6f107, createdName=liye789132251, createdTime=Sat Dec 19 09:55:32 CST 2020, time=2020-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=808233, encodeId=5458808233f9, content=恐怖, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200620/aa639dfc8a1a4edf8fd1a054e00988dd/d30946ee96694a4f8aa034f2e536c052.jpg, createdBy=23f62697515, createdName=ms5000001417824766, createdTime=Wed Aug 12 17:18:19 CST 2020, time=2020-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1468727, encodeId=e5341468e27c6, content=<a href='/topic/show?id=a19b4540688' target=_blank style='color:#2F92EE;'>#季节#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45406, encryptionId=a19b4540688, topicName=季节)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cf986929326, createdName=30397606, createdTime=Mon Jun 22 09:55:32 CST 2020, time=2020-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1533428, encodeId=a98f1533428bb, content=<a href='/topic/show?id=fe21454096b' target=_blank style='color:#2F92EE;'>#季节性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45409, encryptionId=fe21454096b, topicName=季节性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e4bd12435949, createdName=charleshjw, createdTime=Mon Jun 22 09:55:32 CST 2020, time=2020-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1591033, encodeId=b8b41591033aa, content=<a href='/topic/show?id=fe4a4541460' target=_blank style='color:#2F92EE;'>#季节性流感#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45414, encryptionId=fe4a4541460, topicName=季节性流感)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4d9717894537, createdName=sjzlzc013, createdTime=Mon Jun 22 09:55:32 CST 2020, time=2020-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1610538, encodeId=9cee1610538ec, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Mon Jun 22 09:55:32 CST 2020, time=2020-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1028211, encodeId=e5d2102821187, content=新冠肺炎,疫情何时才能消失, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=公卫新人, createdTime=Sat Jun 20 21:55:32 CST 2020, time=2020-06-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=799283, encodeId=0ed4e9928363, content=新冠肺炎的疫苗,即使成功,也很难完全杜绝病毒。, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sat Jun 20 19:58:35 CST 2020, time=2020-06-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=799282, encodeId=7536e992825c, content=<a href='/topic/show?id=46ce580e865' target=_blank style='color:#2F92EE;'>#新冠肺炎#</a>情况仍然令人担忧🐴🐴🐝🐝, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58078, encryptionId=46ce580e865, topicName=新冠肺炎)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sat Jun 20 19:58:11 CST 2020, time=2020-06-20, status=1, ipAttribution=)]
    2020-06-20 lovetcm

    新冠肺炎的疫苗,即使成功,也很难完全杜绝病毒。

    0

  10. [GetPortalCommentsPageByObjectIdResponse(id=1745864, encodeId=0a211e458645a, content=<a href='/topic/show?id=34a5666451b' target=_blank style='color:#2F92EE;'>#演变#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66645, encryptionId=34a5666451b, topicName=演变)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=96a135615295, createdName=oliver181, createdTime=Tue Feb 09 21:55:32 CST 2021, time=2021-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1884402, encodeId=044d188440213, content=<a href='/topic/show?id=3b2112532d8' target=_blank style='color:#2F92EE;'>#Nat#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12532, encryptionId=3b2112532d8, topicName=Nat)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e6f107, 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attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cf986929326, createdName=30397606, createdTime=Mon Jun 22 09:55:32 CST 2020, time=2020-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1533428, encodeId=a98f1533428bb, content=<a href='/topic/show?id=fe21454096b' target=_blank style='color:#2F92EE;'>#季节性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45409, encryptionId=fe21454096b, topicName=季节性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e4bd12435949, createdName=charleshjw, createdTime=Mon Jun 22 09:55:32 CST 2020, time=2020-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1591033, encodeId=b8b41591033aa, content=<a href='/topic/show?id=fe4a4541460' target=_blank style='color:#2F92EE;'>#季节性流感#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45414, encryptionId=fe4a4541460, topicName=季节性流感)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4d9717894537, createdName=sjzlzc013, createdTime=Mon Jun 22 09:55:32 CST 2020, time=2020-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1610538, encodeId=9cee1610538ec, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Mon Jun 22 09:55:32 CST 2020, time=2020-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1028211, encodeId=e5d2102821187, content=新冠肺炎,疫情何时才能消失, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=公卫新人, createdTime=Sat Jun 20 21:55:32 CST 2020, time=2020-06-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=799283, encodeId=0ed4e9928363, content=新冠肺炎的疫苗,即使成功,也很难完全杜绝病毒。, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sat Jun 20 19:58:35 CST 2020, time=2020-06-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=799282, encodeId=7536e992825c, content=<a href='/topic/show?id=46ce580e865' target=_blank style='color:#2F92EE;'>#新冠肺炎#</a>情况仍然令人担忧🐴🐴🐝🐝, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58078, encryptionId=46ce580e865, topicName=新冠肺炎)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sat Jun 20 19:58:11 CST 2020, time=2020-06-20, status=1, ipAttribution=)]
    2020-06-20 lovetcm

    #新冠肺炎#情况仍然令人担忧🐴🐴🐝🐝

    0

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