NEJM:血浆置换和糖皮质激素减量治疗严重ANCA相关性血管炎疗效不显著(PEXIVAS 研究)

2020-02-20 MedSci MedSci

ANCA相关性血管炎(AAV)是一组小血管炎,包括肉芽肿性多血管炎(GPA),显微镜下多血管炎和嗜酸性肉芽肿性血管炎,也可出现肾局限性血管炎。肾脏组织学显示寡免疫性、局灶坏死性和新月体性GN。寡免疫指少量免疫和补体沉积。AAV特点为髓过氧化物酶ANCA(MPO-ANCA)或蛋白酶3ANCA(PR3-ANCA)阳性。少量寡免疫性GN患者ANCA为阴性,但同样属于AAV。糖皮质激素广泛用于AAV的治疗

ANCA相关性血管炎(AAV)是一组小血管炎,包括肉芽肿性多血管炎(GPA),显微镜下多血管炎和嗜酸性肉芽肿性血管炎,也可出现肾局限性血管炎。肾脏组织学显示寡免疫性、局灶坏死性和新月体性GN。寡免疫指少量免疫和补体沉积。AAV特点为髓过氧化物酶ANCA(MPO-ANCA)或蛋白酶3ANCA(PR3-ANCA)阳性。少量寡免疫性GN患者ANCA为阴性,但同样属于AAV。糖皮质激素广泛用于AAV的治疗,常用剂量为500-1000mg/d脉冲1-3天,尤其是快速进展性GN患者。但糖皮质激素单一治疗无效,且可导致不良反应。

常规治疗分为诱导治疗与维持治疗两个阶段。

在诱导治疗阶段,CYC一直是首选的免疫抑制剂,虽然在AAV管理方面有效,但其安全性还需与其他治疗药物相比较。最近研究证实,血肌酐<4 mg/dl(354μmol/l)的AAN患者使用RTX的有效性与CYC诱导/AZA维持一样。

诱导缓解后即开始维持治疗,一般在诱导后3-6个月,使用药物通常为AZA或RTX。AAV维持治疗的时间尚未达成共识。根据ANCA血清学和治疗的不同,持续时间长短不一。

最近,加拿大麦克马斯特大学Michael Walsh团队近日取得一项新成果。他们研究了血浆置换和糖皮质激素治疗严重ANCA相关性血管炎的疗效。这一研究成果发表在2020年2月13日出版的国际学术期刊《新英格兰医学杂志》上。

抗中性粒细胞胞浆抗体(ANCA)相关性血管炎需要更有效、更安全的治疗。

研究组进行了一项随机试验,招募严重ANCA相关性血管炎患者,采用2*2因子设计,将其随机分组分别进行血浆置换或不进行血浆置换;同时随机分组接受标准剂量糖皮质激素或减量糖皮质激素进行治疗。

随访7年后,血浆置换组的352例患者中有100例(28.4%)发生全因死亡或终末期肾病(ESKD),对照组352例患者中有109例(31.0%),差异不显著。亚组和次要指标分析结果亦相差不大。

糖皮质激素减量组的330例患者中有92例(27.9%)发生全因死亡或ESKD,标准剂量组325例患者中有83例(25.5%),符合非劣效性标准。减量组1年内严重感染的发生率显著低于标准剂量组,但其他次要指标相差不大。

总之,对于严重ANCA相关性血管炎患者,血浆置换并不能降低死亡或ESKD的发生率,糖皮质激素减量治疗亦不优于标准剂量方案。

原始出处:

Walsh M, Merkel PA, Peh CA, Szpirt WM, Puéchal X, Fujimoto S, Hawley CM, Khalidi N, Floßmann O, Wald R, Girard LP, Levin A, Gregorini G, Harper L, Clark WF, Pagnoux C, Specks U, Smyth L, Tesar V, Ito-Ihara T, de Zoysa JR, Szczeklik W, Flores-Suárez LF, Carette S, Guillevin L, Pusey CD, Casian AL, Brezina B, Mazzetti A, McAlear CA, Broadhurst E, Reidlinger D, Mehta S, Ives N, Jayne DRW; PEXIVAS Investigators. Plasma Exchange and Glucocorticoids in Severe ANCA-Associated Vasculitis.N Engl J Med. 2020 Feb 13;382(7):622-631. doi: 10.1056/NEJMoa1803537.

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    2020-06-06 yxch48
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GetPortalCommentsPageByObjectIdResponse(id=1035136, encodeId=38771035136dd, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Feb 20 10:30:00 CST 2020, time=2020-02-20, status=1, ipAttribution=)]
    2020-08-22 feather89
  4. [GetPortalCommentsPageByObjectIdResponse(id=1837795, encodeId=950f183e795aa, content=<a href='/topic/show?id=3f34e253206' target=_blank style='color:#2F92EE;'>#相关性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72532, encryptionId=3f34e253206, topicName=相关性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a9de34, createdName=shenxlcyp, createdTime=Tue Nov 17 18:30:00 CST 2020, time=2020-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1742679, encodeId=7e211e4267918, content=<a href='/topic/show?id=39cae96626f' target=_blank style='color:#2F92EE;'>#置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79662, encryptionId=39cae96626f, topicName=置换)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3a7c35056336, 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encryptionId=b5f6e6827fb, topicName=糖皮质)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0f4230340116, createdName=Tommy1959, createdTime=Sat Nov 14 19:30:00 CST 2020, time=2020-11-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1263241, encodeId=95d81263241bc, content=<a href='/topic/show?id=581e8968859' target=_blank style='color:#2F92EE;'>#血管炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89688, encryptionId=581e8968859, topicName=血管炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=909c71, createdName=shijzhiewnjhch, createdTime=Fri Feb 21 22:30:00 CST 2020, time=2020-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1400813, encodeId=0c1314008138b, content=<a href='/topic/show?id=0ba9248543' target=_blank style='color:#2F92EE;'>#ANCA#</a>, beContent=null, objectType=article, 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GetPortalCommentsPageByObjectIdResponse(id=1600405, encodeId=80c5160040586, content=<a href='/topic/show?id=3565e21649e' target=_blank style='color:#2F92EE;'>#皮质激素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72164, encryptionId=3565e21649e, topicName=皮质激素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cb1a18781011, createdName=bbwznl, createdTime=Fri Feb 21 22:30:00 CST 2020, time=2020-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032410, encodeId=024d10324106e, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Thu Feb 20 10:30:00 CST 2020, time=2020-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035136, encodeId=38771035136dd, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Feb 20 10:30:00 CST 2020, time=2020-02-20, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1837795, encodeId=950f183e795aa, content=<a href='/topic/show?id=3f34e253206' target=_blank style='color:#2F92EE;'>#相关性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72532, encryptionId=3f34e253206, topicName=相关性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a9de34, createdName=shenxlcyp, createdTime=Tue Nov 17 18:30:00 CST 2020, time=2020-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1742679, encodeId=7e211e4267918, content=<a href='/topic/show?id=39cae96626f' target=_blank style='color:#2F92EE;'>#置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79662, encryptionId=39cae96626f, topicName=置换)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3a7c35056336, 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channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2485, encryptionId=0ba9248543, topicName=ANCA)], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/101296147/EE600EF84628E8BB8DF2285885814D26/100, createdBy=116f2265509, createdName=Boyinsh, createdTime=Fri Feb 21 22:30:00 CST 2020, time=2020-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1485790, encodeId=48461485e90f4, content=<a href='/topic/show?id=e75889215f7' target=_blank style='color:#2F92EE;'>#血浆置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89215, encryptionId=e75889215f7, topicName=血浆置换)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ed838051612, createdName=12498e8em74暂无昵称, createdTime=Fri Feb 21 22:30:00 CST 2020, time=2020-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1600405, encodeId=80c5160040586, content=<a href='/topic/show?id=3565e21649e' target=_blank style='color:#2F92EE;'>#皮质激素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72164, encryptionId=3565e21649e, topicName=皮质激素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cb1a18781011, createdName=bbwznl, createdTime=Fri Feb 21 22:30:00 CST 2020, time=2020-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032410, encodeId=024d10324106e, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Thu Feb 20 10:30:00 CST 2020, time=2020-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035136, encodeId=38771035136dd, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Feb 20 10:30:00 CST 2020, time=2020-02-20, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1837795, encodeId=950f183e795aa, content=<a href='/topic/show?id=3f34e253206' target=_blank style='color:#2F92EE;'>#相关性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72532, encryptionId=3f34e253206, topicName=相关性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a9de34, createdName=shenxlcyp, createdTime=Tue Nov 17 18:30:00 CST 2020, time=2020-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1742679, encodeId=7e211e4267918, content=<a href='/topic/show?id=39cae96626f' target=_blank style='color:#2F92EE;'>#置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79662, encryptionId=39cae96626f, topicName=置换)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3a7c35056336, 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encryptionId=b5f6e6827fb, topicName=糖皮质)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0f4230340116, createdName=Tommy1959, createdTime=Sat Nov 14 19:30:00 CST 2020, time=2020-11-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1263241, encodeId=95d81263241bc, content=<a href='/topic/show?id=581e8968859' target=_blank style='color:#2F92EE;'>#血管炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89688, encryptionId=581e8968859, topicName=血管炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=909c71, createdName=shijzhiewnjhch, createdTime=Fri Feb 21 22:30:00 CST 2020, time=2020-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1400813, encodeId=0c1314008138b, content=<a href='/topic/show?id=0ba9248543' target=_blank style='color:#2F92EE;'>#ANCA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2485, encryptionId=0ba9248543, topicName=ANCA)], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/101296147/EE600EF84628E8BB8DF2285885814D26/100, createdBy=116f2265509, createdName=Boyinsh, createdTime=Fri Feb 21 22:30:00 CST 2020, time=2020-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1485790, encodeId=48461485e90f4, content=<a href='/topic/show?id=e75889215f7' target=_blank style='color:#2F92EE;'>#血浆置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89215, encryptionId=e75889215f7, topicName=血浆置换)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ed838051612, createdName=12498e8em74暂无昵称, createdTime=Fri Feb 21 22:30:00 CST 2020, time=2020-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1600405, encodeId=80c5160040586, content=<a href='/topic/show?id=3565e21649e' target=_blank style='color:#2F92EE;'>#皮质激素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72164, encryptionId=3565e21649e, topicName=皮质激素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cb1a18781011, createdName=bbwznl, createdTime=Fri Feb 21 22:30:00 CST 2020, time=2020-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032410, encodeId=024d10324106e, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Thu Feb 20 10:30:00 CST 2020, time=2020-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035136, encodeId=38771035136dd, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Feb 20 10:30:00 CST 2020, time=2020-02-20, status=1, ipAttribution=)]
    2020-02-21 Boyinsh
  7. [GetPortalCommentsPageByObjectIdResponse(id=1837795, encodeId=950f183e795aa, content=<a href='/topic/show?id=3f34e253206' target=_blank style='color:#2F92EE;'>#相关性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72532, encryptionId=3f34e253206, topicName=相关性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a9de34, createdName=shenxlcyp, createdTime=Tue Nov 17 18:30:00 CST 2020, time=2020-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1742679, encodeId=7e211e4267918, content=<a href='/topic/show?id=39cae96626f' target=_blank style='color:#2F92EE;'>#置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79662, encryptionId=39cae96626f, topicName=置换)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3a7c35056336, createdName=yxch48, createdTime=Sat Jun 06 04:30:00 CST 2020, time=2020-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1728309, encodeId=72901e2830909, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Sat Aug 22 05:30:00 CST 2020, time=2020-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1701279, encodeId=79661e0127951, content=<a href='/topic/show?id=b5f6e6827fb' target=_blank style='color:#2F92EE;'>#糖皮质#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76827, encryptionId=b5f6e6827fb, topicName=糖皮质)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0f4230340116, createdName=Tommy1959, createdTime=Sat Nov 14 19:30:00 CST 2020, time=2020-11-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1263241, encodeId=95d81263241bc, content=<a href='/topic/show?id=581e8968859' target=_blank style='color:#2F92EE;'>#血管炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89688, encryptionId=581e8968859, topicName=血管炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=909c71, createdName=shijzhiewnjhch, createdTime=Fri Feb 21 22:30:00 CST 2020, time=2020-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1400813, encodeId=0c1314008138b, content=<a href='/topic/show?id=0ba9248543' target=_blank style='color:#2F92EE;'>#ANCA#</a>, beContent=null, objectType=article, 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GetPortalCommentsPageByObjectIdResponse(id=1600405, encodeId=80c5160040586, content=<a href='/topic/show?id=3565e21649e' target=_blank style='color:#2F92EE;'>#皮质激素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72164, encryptionId=3565e21649e, topicName=皮质激素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cb1a18781011, createdName=bbwznl, createdTime=Fri Feb 21 22:30:00 CST 2020, time=2020-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032410, encodeId=024d10324106e, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Thu Feb 20 10:30:00 CST 2020, time=2020-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035136, encodeId=38771035136dd, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Feb 20 10:30:00 CST 2020, time=2020-02-20, status=1, ipAttribution=)]
  8. [GetPortalCommentsPageByObjectIdResponse(id=1837795, encodeId=950f183e795aa, content=<a href='/topic/show?id=3f34e253206' target=_blank style='color:#2F92EE;'>#相关性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72532, encryptionId=3f34e253206, topicName=相关性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a9de34, createdName=shenxlcyp, createdTime=Tue Nov 17 18:30:00 CST 2020, time=2020-11-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1742679, encodeId=7e211e4267918, content=<a href='/topic/show?id=39cae96626f' target=_blank style='color:#2F92EE;'>#置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79662, encryptionId=39cae96626f, topicName=置换)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3a7c35056336, 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GetPortalCommentsPageByObjectIdResponse(id=1035136, encodeId=38771035136dd, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Feb 20 10:30:00 CST 2020, time=2020-02-20, status=1, ipAttribution=)]
  9. 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channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2485, encryptionId=0ba9248543, topicName=ANCA)], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/101296147/EE600EF84628E8BB8DF2285885814D26/100, createdBy=116f2265509, createdName=Boyinsh, createdTime=Fri Feb 21 22:30:00 CST 2020, time=2020-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1485790, encodeId=48461485e90f4, content=<a href='/topic/show?id=e75889215f7' target=_blank style='color:#2F92EE;'>#血浆置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89215, encryptionId=e75889215f7, topicName=血浆置换)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ed838051612, createdName=12498e8em74暂无昵称, createdTime=Fri Feb 21 22:30:00 CST 2020, time=2020-02-21, status=1, ipAttribution=), 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GetPortalCommentsPageByObjectIdResponse(id=1035136, encodeId=38771035136dd, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Feb 20 10:30:00 CST 2020, time=2020-02-20, status=1, ipAttribution=)]
    2020-02-20 内科新手

    谢谢梅斯提供这么好的信息,学到很多

    0

  10. 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channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2485, encryptionId=0ba9248543, topicName=ANCA)], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/101296147/EE600EF84628E8BB8DF2285885814D26/100, createdBy=116f2265509, createdName=Boyinsh, createdTime=Fri Feb 21 22:30:00 CST 2020, time=2020-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1485790, encodeId=48461485e90f4, content=<a href='/topic/show?id=e75889215f7' target=_blank style='color:#2F92EE;'>#血浆置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89215, encryptionId=e75889215f7, topicName=血浆置换)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ed838051612, createdName=12498e8em74暂无昵称, createdTime=Fri Feb 21 22:30:00 CST 2020, time=2020-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1600405, encodeId=80c5160040586, content=<a href='/topic/show?id=3565e21649e' target=_blank style='color:#2F92EE;'>#皮质激素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72164, encryptionId=3565e21649e, topicName=皮质激素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cb1a18781011, createdName=bbwznl, createdTime=Fri Feb 21 22:30:00 CST 2020, time=2020-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032410, encodeId=024d10324106e, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Thu Feb 20 10:30:00 CST 2020, time=2020-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035136, encodeId=38771035136dd, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Feb 20 10:30:00 CST 2020, time=2020-02-20, status=1, ipAttribution=)]
    2020-02-20 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

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