一文读懂高渗性非酮症糖尿病昏迷

2019-04-08 二军大 医谷

患者男性,67岁,广东人,因多尿、多饮2周,昏迷4小时于8月31日入院。

患者男性,67岁,广东人,因多尿、多饮2周,昏迷4小时于8月31日入院。

患者2周前无明显诱因出现多尿,夜尿每晚4-5次,日尿约10次,每次量100-200ml。饮水量也明显增加,每日饮水量约8磅。1周前开始有头晕、四肢乏力,食欲减低,视物模糊,无旋转感,无耳鸣及肢体感觉障碍。2天前曾于走路时跌倒,无外伤,但未就诊。今天自觉发热(体温未测),午饭后上腹痛,且十分困倦而入睡。4小时前家人因其久睡不起而探视,但呼之不应,摇之不醒,即急诊入院。起病以来大便秘结,体重减轻5公斤。无心悸、气促,无尿急、尿痛,无水肿。

既往无肝炎、肾炎、结核、高血压糖尿病病史,无外伤、手术及药物过敏史。体检:T38.5℃,P96次/分,R30次/分,BP18/10kPa。发育正常,营养一般,神志昏迷,按压眶上神经无反应。唇舌干燥,呈红色。皮肤干燥弹性差,无出血点及瘀斑。巩膜无黄染,双侧瞳孔直径3.0mm,等大等圆,对光反射迟。全身浅表淋巴结未触及。颈软,气管居中,甲状腺不大。胸廓对称,无异形,两肺呼吸音清,未闻干湿啰音。心界正常,心律整齐,心率96次/分,各瓣膜听诊区未闻及病理性杂音。腹平软,肝,脾未触及,肝颈征(-),腹水征(-)。脊柱、四肢无畸形,无水肿;关节无畸形、红、肿、热:四肢肌张力低,双反射减弱至消失,未引出病理性神经反射。

实验室检查:血红蛋白150g/L,红细胞4.70X1012/L:白细胞1.8×1012/L。分类:中性0.78,淋巴0.22,血小板158x1012/L。

尿常规:蛋白(-)、尿糖(++++),尿酮体(-)。

生化检查:血钠177mmoL/L,血钾5.0mmol/L,血糖43.8mmol/L,血尿素氮13.3mmol/L,肌酐157mmol/L,二氧化碳结合力26 mmol/L。

肝功能正常。心电图正常

讨论

实习医生A:本例的病情特点:①男性,67岁:②先多尿、多饮,后昏迷;③发热、失水征明显;①体检心、肺、肝、脾未发现异常,肝功能正常:③白细胞数升高:尿糖4个+,酮体(-),高血糖、高血钠,二氧化碳结合力正常。

实习医生B:根据患者的病情特点,有多尿、多饮症状,入院后检查尿糖4个(+)血糖43.8 mmol/L,可考虑是糖尿病性昏迷。

教师:糖尿病病人发生昏迷可有症酸中毒昏迷、高渗性非酮症糖尿病昏迷、乳酸性酸中毒和低血糖昏迷,本例属哪一种?

实习医生C:患者血糖高,尿糖4个(+),但酮体(-),二氧化碳结合力正常,所以不是酮症酸中毒昏迷,更不是低血糖昏迷,且血浆有效透压为407.8mOsm/(kg·H2O),明显>320mOm/(kg·H20)的正常范围,因此可诊断为高性非症糖尿病昏迷。

教师:乳酸性酸中毒较少见,一般在糖尿病患者有肝、肾功能不全、休克、饮酒、缺氧、服用双胍类药物等情况下,因体内乳酸产生过多或利用、清除障碍时发生。本例不存在这些诱因,患者尿素氯及肌酐虽高于正常,但这在糖尿病症酸中毒及高性非症昏迷患者很常见,属一过性者。白细胞、血红蛋白、红细胞数增高也是如此,这是失水和血液浓缩所致,经治疗清醒后可恢复正常。如血尿素氮及肌酐不能恢复,则结合尿蛋白等需考虑糖尿病肾病问题。同样,伴感染者自细胞增多需控制感染后才能恢复。

高渗性非酮症昏迷多见于老年患者,好发年龄为50-70岁,且很多病人无糖尿病病史或症状很轻。特征是失水很严重,失水征明显,血钠和血糖明显升高,血糖常在33.3mmol/L以上,血钠可达155mmol/L以上,因此血浆透压也明显高于正常。我同意大家的诊断

实习医生D:老师,酮症酸中毒昏迷与高渗昏迷在临床上主要有哪些不同呢?

教师:高渗性昏迷者因自身胰岛素水平尚能抑制脂肪的动员和分解及高血糖和高渗透压也可抑制酮体生成,因而不出现酮症或很轻。二者均明显失水及有神经系统症状,但高渗性昏迷更严重,失水量可超过原来体重12%以上,神经系统症状可有不同程度的偏瘫,失语症,幻觉,痫样发作等。高血糖,高渗透压也较酮症者严重,酮症酸中毒者血糖多不超过33.3 mmol/L,但高渗性昏迷却在33.3moL以上。

大家对本例的分析是对的,但如果在实验室检查前,对于一个昏迷病人,我们又该如何考虑,并做哪些相应的检查,以做出准确的诊断呢?

实习医生E:我们应考虑临床上常见的可引起昏迷的原因,除上面提到的以外,低血糖也可发生于非糖尿病者,另外如严重感染、中毒、肝昏迷、尿毒症、高血压脑病、脑血管意外、脑外伤、脑肿瘤、阿斯综合征等均可致昏迷。我们需详细询问病史,仔细进行体检,通过可靠的病史与心、肺、肝、脾、神经系统的检查,再做尿常规及血液生化等有关的检查,会得到提示,必要时可进行心电图和有关的影像学检查,如头颅CT等。

教师:对于昏迷病人应认真进行鉴别诊断。失水征对于诊断糖尿病症酸中毒与高渗性昏迷是一个十分重要的提示。患者表现出皮肤粘膜极度干燥,皮肤缺乏弹性,唇舌呈绛红色,面颊潮红,眼压低等严重失水征。如患者无水摄入不足和非经脱水治疗,无尿崩症史和大量出汗等使水分大量丢失的情况,则需警惕本症的可能,马上做尿糖与微量血糖的检查可获得初步诊断,并即可进行治疗。当然最后确诊还需有待多种生化检查的结果才能做出。

低血糖昏迷则相反,患者皮肤湿润多汗,尿糖、尿酮体阴性,血糖低于2.8mmol/L。有糖尿病病史者,一般是注射胰岛素或服用降糖药后未能及时进食或进食过少或体力劳动后发生,这也可从病史上得到提示。

高渗性非症糖尿病昏迷应特别注意与脑血管意外鉴别,因患者年龄大,常有高血压动脉硬化,在此基础上易发生脑血管意外。后者应有明显的神经系统症状及定位体征,应根据血糖,尿体或脑脊液及头颅CT检查等鉴别,还需注意二者也可同时存在。

一经明确诊断,治方刻不容缓,你将使用哪些治疗措施?

实习医生F:应用小剂量胰岛素治疗

实习医生G:输液。

教师:补充液体是首要的治疗措施,因病人严重失水,在有效的组织灌注恢复前,胰岛素不能充分发挥生理效应。而对补液的质和量方面又该如何掌握呢?

实习医生G:老师,应该输低渗液还是等渗液呢?

教师:这是一个有争议的问题。我们认为输进低渗液可致血浆透压下降,因细胞内、外液透压下降不平衡,可能使液体进入细胞内而诱发脑水肿;也可能引起溶血。并且等渗氯化钠对于这种病人来说已属“低”,因此应先输等渗液,当血糖降至≤13.9mmol/L时,改用5%葡萄糖溶液或葡萄糖盐水液,其中每3-4g葡萄糖加入1单位速效胰岛素。

在补液的量方面,第1-2小时需快速输入1000-2000ml液体,为达到快速补液目的,需专用一静脉通道补充液体,另一静脉通道用作肤岛素治疗。第3小时以后逐渐减慢速度,头24小时输液量可根据病人的尿量、血压、失水情况决定,一般4000-5000ml。由于患者年龄较大,应注意心功能情况,最好能做中心静脉压测定,以指导补液量与补液速度。

关于胰岛素使用问题,刚才同学提到小剂量胰岛素,可否谈谈具体用法?

实习医生F:小剂量胰岛素治疗即按病人体重,每公斤每小时使用0.1单位,一般每小时给于速效胰岛素6单位,可在生理盐水500ml中加入速效胰岛素50单位,以每分钟16滴的速度静注。

教师:很好。小剂量胰岛素同样用于酮症酸中毒昏迷治疗,既安全,而且效果好,以每小时每公斤0.1单位的速度补给胰岛素,就能阻止脂肪分解,酮体生成,糖原分解,糖异生,血糖下降速度为每小时3.9-6.1mmol/L。当血糖降至≤13.9 mmol/L时,停用小剂量治疗,改用5%葡萄糖溶液或葡萄糖盐水液,补液中每3-4g葡萄糖加入1单位胰岛素。

在治疗过程中,我们还要注意电解质的平衡,如治疗前血钾低,应在开始治疗时就补钾。本例治疗前血钾量不低,经大量补液与应用胰岛素4-6小时后,血钾常明显下降。因而若尿量>40ml/h,则应在补液和使用胰岛素同时补钾。

当然,在整个治疗过程中应严密监测,及时发现和处理体克、脑水肿、心肌梗死、心功能不全等并发症,同时处理感染等诱因。

通过本例,我们要注意下面三个问题:

(1)对于老年昏迷者,大家往往首先考虑的是脑血管意外,而忽略了有关糖尿病的病史及检查,这可能导致误诊,并且按照脑血管意外治疗又会加重糖尿病病情。

(2)认识高渗性非酮症糖尿病昏迷的临床特征有助于从昏迷病人中发现本症患者。高渗性昏迷的特征是高龄发病、高血糖、高血钠、高港透压。病人原有的糖尿病症状轻,甚或无病史,有如本例。而失水征是最值得关注的体征。

(3)关于糖尿病症酸中毒和高性非症昏迷的治疗,往往认为最重要的是使用胰岛素,其实补充液体才是最重要的。通过快速补液改善有效的组织灌注是治疗的关键。当然小剂量胰岛素治疗和纠正电解质紊乱也是必要的治疗措施。

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    2019-12-09 zexyw01
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  3. [GetPortalCommentsPageByObjectIdResponse(id=1819726, encodeId=d3101819e26ff, content=<a href='/topic/show?id=06b499e326c' target=_blank style='color:#2F92EE;'>#非酮症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99732, encryptionId=06b499e326c, topicName=非酮症)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=362b271, createdName=zexyw01, createdTime=Mon Dec 09 01:05:00 CST 2019, time=2019-12-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2086195, encodeId=a54920861954e, content=<a href='/topic/show?id=23ba1024e08c' target=_blank style='color:#2F92EE;'>#高渗性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102470, encryptionId=23ba1024e08c, topicName=高渗性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=docwu2019, createdTime=Sun Sep 22 23:05:00 CST 2019, time=2019-09-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1804297, encodeId=92ba180429e1e, content=<a href='/topic/show?id=9521e673371' target=_blank style='color:#2F92EE;'>#糖尿病昏迷#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76733, encryptionId=9521e673371, topicName=糖尿病昏迷)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87b1109, createdName=kcb069, createdTime=Fri Feb 21 13:05:00 CST 2020, time=2020-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1641204, encodeId=92b8164120429, content=<a href='/topic/show?id=8d739553475' target=_blank style='color:#2F92EE;'>#酮症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95534, encryptionId=8d739553475, topicName=酮症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=790822763597, createdName=ms705947299214030, createdTime=Fri May 03 08:05:00 CST 2019, time=2019-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1429495, encodeId=cc621429495e5, content=<a href='/topic/show?id=26d559642f9' target=_blank style='color:#2F92EE;'>#昏迷#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59642, encryptionId=26d559642f9, topicName=昏迷)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=81fb4200032, createdName=wgx307, createdTime=Wed Apr 10 01:05:00 CST 2019, time=2019-04-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1042368, encodeId=b3e7104236854, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Mon Apr 08 13:05:00 CST 2019, time=2019-04-08, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=1819726, encodeId=d3101819e26ff, content=<a href='/topic/show?id=06b499e326c' target=_blank style='color:#2F92EE;'>#非酮症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99732, encryptionId=06b499e326c, topicName=非酮症)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=362b271, createdName=zexyw01, createdTime=Mon Dec 09 01:05:00 CST 2019, time=2019-12-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2086195, encodeId=a54920861954e, content=<a href='/topic/show?id=23ba1024e08c' target=_blank style='color:#2F92EE;'>#高渗性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102470, encryptionId=23ba1024e08c, topicName=高渗性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=docwu2019, createdTime=Sun Sep 22 23:05:00 CST 2019, time=2019-09-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1804297, encodeId=92ba180429e1e, content=<a href='/topic/show?id=9521e673371' target=_blank style='color:#2F92EE;'>#糖尿病昏迷#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76733, encryptionId=9521e673371, topicName=糖尿病昏迷)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87b1109, createdName=kcb069, createdTime=Fri Feb 21 13:05:00 CST 2020, time=2020-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1641204, encodeId=92b8164120429, content=<a href='/topic/show?id=8d739553475' target=_blank style='color:#2F92EE;'>#酮症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95534, encryptionId=8d739553475, topicName=酮症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=790822763597, createdName=ms705947299214030, createdTime=Fri May 03 08:05:00 CST 2019, time=2019-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1429495, encodeId=cc621429495e5, content=<a href='/topic/show?id=26d559642f9' target=_blank style='color:#2F92EE;'>#昏迷#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59642, encryptionId=26d559642f9, topicName=昏迷)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=81fb4200032, createdName=wgx307, createdTime=Wed Apr 10 01:05:00 CST 2019, time=2019-04-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1042368, encodeId=b3e7104236854, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Mon Apr 08 13:05:00 CST 2019, time=2019-04-08, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1819726, encodeId=d3101819e26ff, content=<a href='/topic/show?id=06b499e326c' target=_blank style='color:#2F92EE;'>#非酮症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99732, encryptionId=06b499e326c, topicName=非酮症)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=362b271, createdName=zexyw01, createdTime=Mon Dec 09 01:05:00 CST 2019, time=2019-12-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2086195, encodeId=a54920861954e, content=<a href='/topic/show?id=23ba1024e08c' target=_blank style='color:#2F92EE;'>#高渗性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102470, encryptionId=23ba1024e08c, topicName=高渗性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=docwu2019, createdTime=Sun Sep 22 23:05:00 CST 2019, time=2019-09-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1804297, encodeId=92ba180429e1e, content=<a href='/topic/show?id=9521e673371' target=_blank style='color:#2F92EE;'>#糖尿病昏迷#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76733, encryptionId=9521e673371, topicName=糖尿病昏迷)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87b1109, createdName=kcb069, createdTime=Fri Feb 21 13:05:00 CST 2020, time=2020-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1641204, encodeId=92b8164120429, content=<a href='/topic/show?id=8d739553475' target=_blank style='color:#2F92EE;'>#酮症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95534, encryptionId=8d739553475, topicName=酮症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=790822763597, createdName=ms705947299214030, createdTime=Fri May 03 08:05:00 CST 2019, time=2019-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1429495, encodeId=cc621429495e5, content=<a href='/topic/show?id=26d559642f9' target=_blank style='color:#2F92EE;'>#昏迷#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59642, encryptionId=26d559642f9, topicName=昏迷)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=81fb4200032, createdName=wgx307, createdTime=Wed Apr 10 01:05:00 CST 2019, time=2019-04-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1042368, encodeId=b3e7104236854, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Mon Apr 08 13:05:00 CST 2019, time=2019-04-08, status=1, ipAttribution=)]
    2019-04-10 wgx307
  6. [GetPortalCommentsPageByObjectIdResponse(id=1819726, encodeId=d3101819e26ff, content=<a href='/topic/show?id=06b499e326c' target=_blank style='color:#2F92EE;'>#非酮症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99732, encryptionId=06b499e326c, topicName=非酮症)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=362b271, createdName=zexyw01, createdTime=Mon Dec 09 01:05:00 CST 2019, time=2019-12-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2086195, encodeId=a54920861954e, content=<a href='/topic/show?id=23ba1024e08c' target=_blank style='color:#2F92EE;'>#高渗性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102470, encryptionId=23ba1024e08c, topicName=高渗性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=docwu2019, createdTime=Sun Sep 22 23:05:00 CST 2019, time=2019-09-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1804297, encodeId=92ba180429e1e, content=<a href='/topic/show?id=9521e673371' target=_blank style='color:#2F92EE;'>#糖尿病昏迷#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76733, encryptionId=9521e673371, topicName=糖尿病昏迷)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87b1109, createdName=kcb069, createdTime=Fri Feb 21 13:05:00 CST 2020, time=2020-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1641204, encodeId=92b8164120429, content=<a href='/topic/show?id=8d739553475' target=_blank style='color:#2F92EE;'>#酮症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95534, encryptionId=8d739553475, topicName=酮症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=790822763597, createdName=ms705947299214030, createdTime=Fri May 03 08:05:00 CST 2019, time=2019-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1429495, encodeId=cc621429495e5, content=<a href='/topic/show?id=26d559642f9' target=_blank style='color:#2F92EE;'>#昏迷#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59642, encryptionId=26d559642f9, topicName=昏迷)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=81fb4200032, createdName=wgx307, createdTime=Wed Apr 10 01:05:00 CST 2019, time=2019-04-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1042368, encodeId=b3e7104236854, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Mon Apr 08 13:05:00 CST 2019, time=2019-04-08, status=1, ipAttribution=)]
    2019-04-08 misszhang

    谢谢MedSci提供最新的资讯

    0