FDA全新警告:氟喹诺酮增加总动脉夹层风险,这些人不要再用!

2018-12-23 Gcplive 药评中心

2018年12月20日,美国食品药品监督管理局(FDA)发布最新警告信息

2018年12月20日,美国食品药品监督管理局(FDA)发布最新警告信息:

1、口服或注射氟喹诺酮类抗菌药物,与主动脉夹层或主动脉瘤破裂风险升高相关,可能导致患者发生出血甚至死亡。

2、除非没有其他治疗方案可供选择,氟喹诺酮类药物不应用于下列患者:有主动脉或其他血管阻塞或动脉瘤者,高血压患者,某些累及血管的遗传性疾病患者,老年人。

喹诺酮类抗菌药物已经被屡次警告:

2018年10月5日,欧洲药品管理局(EMA)发布信息:通过对使用氟喹诺酮和喹诺酮发生致残性和潜在长期性副作用报告的评估,建议

1、所有含喹诺酮的药物(吡哌酸等)应撤出市场;

2、限制氟喹诺酮类抗菌药物(口服制剂、注射制剂和吸入剂)的使用。

2017年7月5日,国家食品药品监督管理总局发布《关于修订全身用氟喹诺酮类药品说明书的公告》:

1、黑框警告

当全身用药时(包括口服和注射),氟喹诺酮类药品可能引起肌腱炎、肌腱断裂和重症肌无力病情恶化;

氟喹诺酮类药品可能致残,可能发生多种永久性的严重不良反应,这些严重不良反应可发生在用药后几小时内至几周内,而且可同时发生。

2、适应症

对于急性细菌性鼻窦炎、慢性支气管炎急性发作、单纯性尿路感染和急性非复杂性膀胱炎,只有在没有其他治疗选择的情况下,才可使用氟喹诺酮类!

3、医生职责

临床医师都应该知道氟喹诺酮类的效益和风险,并就其使用作出明智的决定。

十种不良反应

让药品管理部门下狠手

1、肌腱病和肌腱断裂

氟喹诺酮类药品,会使所有年龄段患者的肌腱炎和肌腱断裂的风险增加。这种不良反应最常发生在跟腱,跟腱断裂可能需要手术修复。也有报告在肩、手部、肱二头肌、拇指和其他肌腱点出现肌腱炎和肌腱断裂。

肌腱炎和肌腱断裂可发生在开始用药后数小时或数天,或结束治疗后几个月。肌腱炎和肌腱断裂可双侧发生。这种风险在60岁以上老年患者,服用皮质类固醇药品患者及肾脏、心脏或肺移植手术的患者中进一步增加。

可独立增加肌腱断裂风险的因素包括:剧烈的体力活动,肾功能衰竭以及以前的肌腱疾病,如类风湿关节炎。肌腱炎和肌腱断裂也发生在没有上述风险因素的使用氟喹诺酮类药品的患者中。

患者若发生肌腱疼痛、肿胀、炎症或断裂后,应停止使用本品。在出现肌腱炎或肌腱断裂的迹象后,应建议患者休息,换用非喹诺酮类药品。有肌腱疾病病史或发生过肌腱炎和肌腱断裂的患者应避免使用氟喹诺酮类药品。

2、中枢神经系统疾病

使用氟喹诺酮类药品,已有报告会使中枢神经系统不良反应增加的风险,包括惊厥和颅内压增高(含假性脑瘤)以及中毒引起的精神病。

使用氟喹诺酮类药品可能会导致中枢神经系统反应包括焦躁、激动、失眠、焦虑、噩梦、偏执狂、头晕、错乱、震颤、幻觉、抑郁和自杀想法或行为。这些反应可能发生在首次用药后。如果这些反应发生,应停止给药并采取适当的措施。

已知或怀疑有中枢神经系统疾病的患者(如严重的脑动脉硬化、癫痫)或存在其他风险因素的患者(如有发作倾向或发作阈值降低)应在获益超过风险时使用。

3、周围神经病变

已有报告患者使用氟喹诺酮类药品,产生罕见的感觉或感觉运动性轴索神经病,影响小和/或大的轴索,致皮肤感觉异常、感觉迟钝、触物痛感和衰弱。对于某些患者,症状可能在用药后很快发生并且可能是不可逆的。

如果患者出现外周神经病变症状,包括疼痛、烧灼感、麻刺感、麻木和/或无力,或其他感觉,包括轻触觉、痛觉、温觉、位置觉和振动觉的变化,应立即停药。有周围神经病变病史的患者应避免使用氟喹诺酮类抗生素

——可同时发生、不可逆转

使用喹诺酮,可在同一患者的身体不同器官系统同时发生致残和潜在的不可逆转的严重不良反应,通常包括:肌腱炎,肌腱断裂,关节痛,肌痛,周围神经病变和中枢神经系统反应(幻觉,焦虑,抑郁,失眠,严重头痛和错乱)。

这些不良反应可发生在用药后数小时至数周,任何年龄段的患者,之前没有相关风险因素,均有报告发生这些不良反应。

4、重症肌无力加重

氟喹诺酮类药品,有神经肌肉阻断活性,可能加剧重症肌无力患者的肌无力症状。上市后的严重不良事件,包括死亡和需要通气支持,以及重症肌无力患者与使用氟喹诺酮类药品相关。患有重症肌无力的患者应避免使用。

5、QT间期延长

某些氟喹诺酮类药品可以使心电图的QT间期延长,少数患者可以出现心律失常。上市后监测期间自发报告接受氟喹诺酮类药品治疗的患者出现尖端扭转型室速的情况罕见。

已知QT间期延长的患者、未纠正的低血钾患者及使用IA类(奎尼丁、普鲁卡因胺)和Ⅲ类(胺碘酮、索他洛尔)抗心律失常药品的患者应避免使用。老年患者更容易受药品相关的QT间期的影响。

6、对血糖的干扰

曾有氟喹诺酮类抗生素引起血糖紊乱(如症状性高血糖和低血糖)的报道,这种情况多发生于同时口服降糖药(如优降糖/格列本脲)或使用胰岛素的糖尿病患者。因此对于此类患者,建议应密切监测其血糖变化情况。如果患者在接受治疗时出现低血糖反应,应立即停药并采取适当的治疗措施。

7、光敏感性/光毒性

在使用氟喹诺酮类抗生素后暴露于阳光或紫外线照射下,会发生中度至严重的光敏性/光毒性反应,后者可能表现过度的晒伤反应(例如烧灼感、红斑、水泡、渗出、水肿),常出现在暴露于光的部位(通常是颈部的“V”型区域、前臂伸肌表面、手的背部)。因此,应该避免过度暴露于光源下。发生光毒性反应时应停药。

8、艰难梭菌相关性腹泻

几乎所有的抗菌药品均出现过艰难梭菌相关性腹泻(CDAD)的报告,严重程度从轻度腹泻至严重结肠炎。抗菌药品治疗使结肠的正常菌群改变,从而导致艰难梭菌过度生长。

艰难梭菌产生的毒素A和B,是艰难梭菌相关性腹泻的原因。高毒性的梭菌引起的发病率和死亡率均升高,这些感染抗菌治疗无效,并可能需要结肠切除术。在接受抗生素治疗后,出现腹泻均应考虑CDAD的可能性。因为CDAD可能发生在使用抗菌药品治疗后两个月,因此仔细询问病史是必要的。

如果怀疑或证实艰难梭菌相关性腹泻,可能需要停止目前使用的不针对艰难梭菌的抗生素。应适当补充液体和电解质,补充蛋白质,采用针对艰难梭菌的抗生素治疗,出现临床指征时应进行手术评价。

9、过敏反应

一些患者在第一次给药后即发生,有些反应可伴随有心血管系统衰竭、丧失意识、刺痛、咽或面部水肿、呼吸困难、荨麻疹、瘙痒等。严重的过敏反应需要肾上腺素紧急治疗。

应在第一次出现皮疹或其他任何过敏迹象时停止使用。必要时可进行输氧,静脉注射类固醇,气道管理,包括插管等措施。

10、其他严重并且可能致命的反应

使用氟喹诺酮类药品,已有出现其他严重并且可能致命的事件报告。这些事件中有些是由于过敏,有些则病因不明。这些事件可能是重度的,通常发生在多剂量给药后。

临床表现可包括以下的一个或多个症状:

严重的皮肤反应,如中毒性表皮坏死松解症;血管炎;过敏性肺炎;间质性肾炎;急性肾功能不全或肾衰竭;肝炎、黄疸、急性肝坏死或肝功能衰竭;贫血,包括溶血性贫血和再生障碍性贫血;血小板减少症,包括血栓性血小板减少性紫癜;白细胞减少症;粒细胞缺乏症;全血细胞减少症和/或其他血液学异常。

应在第一次出现皮疹、黄疸或任何其他过敏表现时立即停药并且采取措施。

喹诺酮类药物

避免3种致命相互作用

1、喹诺酮+氨茶碱

喹诺酮类抗菌药与茶碱类合用时,可能导致茶碱血药浓度增高,出现茶碱中毒症状。左氧氟沙星对茶碱的代谢影响很小,但合用时也应密切观察患者情况。

2、喹诺酮+解热镇痛药

喹诺酮类药物与解热镇痛药物同时应用,有引发抽搐的可能。

3、喹诺酮+可致QT间期延长药物

可致QT间期延长的药物:Ⅰa类(奎尼丁,普鲁卡因胺)或Ⅲ类(胺碘酮,索他洛尔)抗心律失常药物;西沙比利、红霉素、抗精神病药和三环类抗抑郁药等。

患者

用药交代需牢记

1、贴签警示

您正在服用喹诺酮类药物,一旦出现任何严重不良反应及相关症状,如肌腱、关节、肌肉疼痛,针样刺痛或刺痛感,混乱和幻觉,应及时告诉医务人员。

2、多喝水

喹诺酮类药物在尿液中溶解度降低可结晶析出,引起结晶尿、血尿,严重者可导致急性肾功能衰竭。故患者在服药期间应多饮水,稀释尿液,每日进水量应在1200 ml以上,避免与有尿碱化作用的药物(如碳酸氢钠、碳酸钙、制酸药、枸橼酸盐)同时使用。

3、躲着太阳走

光敏反应是喹诺酮类药物最常见的不良反应。临床症状主要为光暴露部分皮肤出现痒性红斑、水肿、水泡,严重者可引起皮肤脱落、糜烂。

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#插入话题
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  2. [GetPortalCommentsPageByObjectIdResponse(id=1928449, encodeId=2f40192844976, content=<a href='/topic/show?id=3cf54018620' target=_blank style='color:#2F92EE;'>#喹诺酮#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40186, encryptionId=3cf54018620, topicName=喹诺酮)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=917c196, createdName=sjzlzc007, createdTime=Fri Jan 18 22:25:00 CST 2019, time=2019-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=360192, encodeId=ccd03601927b, content=学习学习努力学习天天学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQpl0ENSJScphsFtdgfibXX1g1IuEYGCjP23UqCd52TxTpSZibtPiclyusaHicnNXd78alaia19Qy1nAFo18/0, createdBy=50381491660, createdName=zwjnj2, createdTime=Fri Feb 08 13:06:55 CST 2019, time=2019-02-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=360191, encodeId=549536019181, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQpl0ENSJScphsFtdgfibXX1g1IuEYGCjP23UqCd52TxTpSZibtPiclyusaHicnNXd78alaia19Qy1nAFo18/0, createdBy=50381491660, createdName=zwjnj2, createdTime=Fri Feb 08 13:06:44 CST 2019, time=2019-02-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=356993, encodeId=39ef35699360, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQpl0ENSJScphsFtdgfibXX1g1IuEYGCjP23UqCd52TxTpSZibtPiclyusaHicnNXd78alaia19Qy1nAFo18/0, createdBy=50381491660, createdName=zwjnj2, createdTime=Wed Jan 02 17:37:55 CST 2019, time=2019-01-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1519589, encodeId=c64e1519589e0, content=<a href='/topic/show?id=b63a3323558' target=_blank style='color:#2F92EE;'>#动脉夹层#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33235, encryptionId=b63a3323558, topicName=动脉夹层)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ae5711287462, createdName=mhzhuang@stu.e, createdTime=Tue Dec 25 14:25:00 CST 2018, time=2018-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1523107, encodeId=8eba152310e8b, content=<a href='/topic/show?id=fe8663915a3' target=_blank style='color:#2F92EE;'>#氟喹诺酮#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63915, encryptionId=fe8663915a3, topicName=氟喹诺酮)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ff0911497072, createdName=doctorzheng, createdTime=Tue Dec 25 14:25:00 CST 2018, time=2018-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=356229, encodeId=dde5356229b7, content=学习了,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Sun Dec 23 23:52:58 CST 2018, time=2018-12-23, status=1, ipAttribution=)]
    2019-02-08 zwjnj2

    学习学习努力学习天天学习

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1928449, encodeId=2f40192844976, content=<a href='/topic/show?id=3cf54018620' target=_blank style='color:#2F92EE;'>#喹诺酮#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40186, encryptionId=3cf54018620, topicName=喹诺酮)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=917c196, createdName=sjzlzc007, createdTime=Fri Jan 18 22:25:00 CST 2019, time=2019-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=360192, encodeId=ccd03601927b, content=学习学习努力学习天天学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQpl0ENSJScphsFtdgfibXX1g1IuEYGCjP23UqCd52TxTpSZibtPiclyusaHicnNXd78alaia19Qy1nAFo18/0, createdBy=50381491660, createdName=zwjnj2, createdTime=Fri Feb 08 13:06:55 CST 2019, time=2019-02-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=360191, encodeId=549536019181, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQpl0ENSJScphsFtdgfibXX1g1IuEYGCjP23UqCd52TxTpSZibtPiclyusaHicnNXd78alaia19Qy1nAFo18/0, createdBy=50381491660, createdName=zwjnj2, createdTime=Fri Feb 08 13:06:44 CST 2019, time=2019-02-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=356993, encodeId=39ef35699360, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQpl0ENSJScphsFtdgfibXX1g1IuEYGCjP23UqCd52TxTpSZibtPiclyusaHicnNXd78alaia19Qy1nAFo18/0, createdBy=50381491660, createdName=zwjnj2, createdTime=Wed Jan 02 17:37:55 CST 2019, time=2019-01-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1519589, encodeId=c64e1519589e0, content=<a href='/topic/show?id=b63a3323558' target=_blank style='color:#2F92EE;'>#动脉夹层#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33235, encryptionId=b63a3323558, topicName=动脉夹层)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ae5711287462, createdName=mhzhuang@stu.e, createdTime=Tue Dec 25 14:25:00 CST 2018, time=2018-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1523107, encodeId=8eba152310e8b, content=<a href='/topic/show?id=fe8663915a3' target=_blank style='color:#2F92EE;'>#氟喹诺酮#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63915, encryptionId=fe8663915a3, topicName=氟喹诺酮)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ff0911497072, createdName=doctorzheng, createdTime=Tue Dec 25 14:25:00 CST 2018, time=2018-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=356229, encodeId=dde5356229b7, content=学习了,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Sun Dec 23 23:52:58 CST 2018, time=2018-12-23, status=1, ipAttribution=)]
    2019-02-08 zwjnj2

    学习学习

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1928449, encodeId=2f40192844976, content=<a href='/topic/show?id=3cf54018620' target=_blank style='color:#2F92EE;'>#喹诺酮#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40186, encryptionId=3cf54018620, topicName=喹诺酮)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=917c196, createdName=sjzlzc007, createdTime=Fri Jan 18 22:25:00 CST 2019, time=2019-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=360192, encodeId=ccd03601927b, content=学习学习努力学习天天学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQpl0ENSJScphsFtdgfibXX1g1IuEYGCjP23UqCd52TxTpSZibtPiclyusaHicnNXd78alaia19Qy1nAFo18/0, createdBy=50381491660, createdName=zwjnj2, createdTime=Fri Feb 08 13:06:55 CST 2019, time=2019-02-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=360191, encodeId=549536019181, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQpl0ENSJScphsFtdgfibXX1g1IuEYGCjP23UqCd52TxTpSZibtPiclyusaHicnNXd78alaia19Qy1nAFo18/0, createdBy=50381491660, createdName=zwjnj2, createdTime=Fri Feb 08 13:06:44 CST 2019, time=2019-02-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=356993, encodeId=39ef35699360, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQpl0ENSJScphsFtdgfibXX1g1IuEYGCjP23UqCd52TxTpSZibtPiclyusaHicnNXd78alaia19Qy1nAFo18/0, createdBy=50381491660, createdName=zwjnj2, createdTime=Wed Jan 02 17:37:55 CST 2019, time=2019-01-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1519589, encodeId=c64e1519589e0, content=<a href='/topic/show?id=b63a3323558' target=_blank style='color:#2F92EE;'>#动脉夹层#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33235, encryptionId=b63a3323558, topicName=动脉夹层)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ae5711287462, createdName=mhzhuang@stu.e, createdTime=Tue Dec 25 14:25:00 CST 2018, time=2018-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1523107, encodeId=8eba152310e8b, content=<a href='/topic/show?id=fe8663915a3' target=_blank style='color:#2F92EE;'>#氟喹诺酮#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63915, encryptionId=fe8663915a3, topicName=氟喹诺酮)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ff0911497072, createdName=doctorzheng, createdTime=Tue Dec 25 14:25:00 CST 2018, time=2018-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=356229, encodeId=dde5356229b7, content=学习了,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Sun Dec 23 23:52:58 CST 2018, time=2018-12-23, status=1, ipAttribution=)]
    2019-01-02 zwjnj2

    学习学习学习

    0

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    2018-12-23 惠映实验室

    学习了,谢谢分享。

    0

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