值得一读:2016肺炎重量级研究汇总(TOP 10)

2016-12-23 MedSci MedSci原创

2016年马上就要结束啦!本文小编总结了“2016肺炎重量级研究汇总”,分享给大家。【1】Pediatrics:为预防侵入性肺炎球菌疾病,早产儿应如何免疫?与足月婴儿相比,早产儿侵袭性肺炎球菌疾病的发病风险较高,且对疫苗的反应较低。有趣的是,越来越多的免疫计划包括减少剂量,2-剂量,肺炎球菌结合疫苗启动计划。本研究旨在评估3种常用的13-价肺炎球菌结合疫苗(PCV13)启动计划免疫在早产儿中的

2016年马上就要结束啦!本文小编总结了“2016肺炎重量级研究汇总”,分享给大家。

【1】Pediatrics:为预防侵入性肺炎球菌疾病,早产儿应如何免疫?

与足月婴儿相比,早产儿侵袭性肺炎球菌疾病的发病风险较高,且对疫苗的反应较低。有趣的是,越来越多的免疫计划包括减少剂量,2-剂量,肺炎球菌结合疫苗启动计划。本研究旨在评估3种常用的13-价肺炎球菌结合疫苗(PCV13)启动计划免疫在早产儿中的免疫原性及和早产儿对疫苗12个月增强剂量的免疫反应。

研究共纳入210名早产儿(<35孕周)随机分组,分别接在2月龄和4月龄时接受PCV13免疫组(减量计划);或2月龄、3月龄和4月龄时(加强计划);或2月龄、4月龄和6月龄时(扩展计划)。所有婴儿接受一个为期12个月的PCV13增强免疫。采用酶联免疫吸附试验在基础免疫和加强免疫后的1个月测量PCV13血清型的特定血清型的肺炎球菌的免疫球蛋白G(IgG)的水平。

基础疫苗接种后,减量、加强和扩展计划组分别有75%、88%和97%的参与者血液中含有至少1/2的PCV13血清型的保护性抗体的浓度。加强免疫后,与减量和加强计划的参与者相比,接受扩展计划的参与者的几何平均浓度明显较低,但几乎所有的参与者,不分免疫计划和血清型,都含有血清保护性IgG浓度。

减量PCV13的初次免疫可导致后面增强IgG的浓度较高,但是基础免疫后的浓度较低。因此,早产儿的最佳疫苗计划将取决于当他们处于侵入性肺炎球菌疾病发病风险最高的时间。(文章详见--Pediatrics:为预防侵入性肺炎球菌疾病,早产儿应如何免疫?

【2】JAMA:成人社区获得性肺炎的抗生素治疗系统性回顾

为了评估抗生素治疗的3个主要方面(最佳使用时间,初次药物选择,从静脉到口服过渡的标准)与成人住院期间社区获得性肺炎短期死亡率的关系。

选择MEDLINE, EMBASE的数据资料,查阅Cochrane Collaboration的关于影像学确诊的社区获得性肺炎的研究,从1995年1月1日到2015年12月5日。

一项群随机试验(n=1737)证明了β-内酰胺(n = 506) vs β-内酰胺加大环内酯治疗 (n = 566)的非劣效性, 绝对差异调整为2.5%(90% CI,−0.6%到90%),90天的死亡率支持β-内酰胺单药治疗。另一个随机试验(n = 580)未能证明的β-内酰胺单药vsβ-内酰胺 +大环内酯物治疗的非劣效性,绝对差异7.6%(单侧90%CI上限,13%)在住院7天支持β-内酰胺 +大环内酯物联合治疗达到临床稳定。

8项观察性研究中的6项(研究人群1188到24 780)发现β-内酰胺+大环内酯联合治疗可减少26%到68%的短期死亡率,3观察性研究(研究人群2068-24 780)报道,氟喹诺酮类单药治疗与β-内酰胺单药治疗相比可减少30%到43%的死亡率。一项随机试验(n = 302)报告显著降低医院住院时间(绝对差,1.9天;95%CI,0.6至3.2天),但在使用客观标准决定病人从静脉到口服用药失败时无显著差异。

结论:对住院的成人社区获得性肺炎,抗生素选用β-内酰胺加大环内酯类或喹诺酮类单药治疗,在住院后4-8小时开始用药与较低的调整后短期死亡率相关,主要由较低质量的观察性研究支持。一项随机的临床试验支持使用客观的临床标准指导从静脉向口服抗生素的过渡。(文章详见--JAMA:成人社区获得性肺炎的抗生素治疗系统性回顾

【3】Am J Med:患肺炎的重度吸烟者中肺癌发生率高达9%!

在美国肺癌位居癌症死亡率首位,5年生存率只有17%。吸烟导致了约85%的肺癌病例,只有15%的患者能够做到早期诊断。新研究表明,对重度吸烟的社区获得性肺炎者进行肺癌筛查,可能有助于肺癌的早期诊断,从而降低死亡率。患有肺炎的重度吸烟者是肺癌高危人群,应及早进行胸部CT筛查肺癌。

肺癌是进展性疾病,只有在症状出现前识别肺癌进行早治疗才能有康复的机会。先前有研究表明,对重度吸烟者进行一年一次的低剂量CT筛查,可以降低肺癌死亡率。但是这需要超级大的资源,并且实际临床中该想法能都有效也不知道。Shepshelovich希望发展一种更现实、更具成本效益的肺癌筛查战略,尤其是针对高风险的人群。

shepshelovich博士和他的团队对381名因社区获得性肺炎住院的重度吸烟者进行了研究。获取患者的医疗档案、人口统计学资料、吸烟史、肺癌危险因素和肺炎解剖位置等相关数据。研究人员发现,381名患肺炎的重度吸烟者中31例(约9%)的患者在一年内被诊断为肺癌。入院时诊断为肺上叶肺炎的患者的肺癌发病率更高(23.8%)。75.8%的肺癌病灶位于肺炎区域。

不伴肺炎的吸烟者每年仅有0.5-1%的机会诊断为肺癌,而伴有肺炎的重度吸烟者肺癌诊断率高达约9%。落差之大应该引起足够的认识和警惕。

目前关于肺癌的诊断方法包括胸部X线检查、痰查肿瘤细胞等,但这些检查方法并不会改变死亡率。也就是说当意识到患上肺癌时,癌症已经存在较长时间。当前肺癌早期发现的数据只有15%左右,研究者希望对肺炎的吸烟者进行胸部CT筛查以提高早诊断率,进而早治疗,降低死亡率。(文章详见--Am J Med:患肺炎的重度吸烟者中肺癌发生率高达9%!

【4】BMJ:质子泵抑制剂对社区获得性肺炎的发生率的影响

该研究采用队列研究和自我对照的病例系列,以英国临床实践研究数据链(1990至2013年)为基础,参与者为首次服用PPI的成年患者,以及相匹配的对照者。社区获得性肺炎与PPI处方之间的相关性通过三种方法进行评估:第一种,校正潜在的混杂因素后,研究人员采用多变量Cox模型来比较服用PPI的患者与对照者患社区获得性肺炎的风险;第二种,自我对照的病例系列;第三种,在首次服用PPI前后12个月内进行之前事件发生率比(PERR)分析。
 
该研究共纳入了160,000名首次服用PPI患者。调整后的Cox回归分析显示服用PPI组发生社区获得性肺炎的风险要比对照组高1.67(95%可信区间为1.55至1.79)倍。在自我对照病例系列中,在48,451名服用过PPI并伴有社区获得性肺炎记录的患者中,在服用PPI30天内发病率比为1.19(95%可信区间为1.14至1.25),但是在服用PPI前30天社区获得性肺炎发病率比更高(1.92,95%可信区间为1.84至2.00)。之前事件发生率比的Cox回归同样显示出在服用PPI前一年社区获得性肺炎的发生率比服用PPI后一年更大。这样的分析表明肺炎相对风险降低与服用PPI有关(之前事件发生率比为0.91,95%置信区间为0.83到0.99)。
 
由此可见,PPIs与社区获得性肺炎风险之间的相关性可能是完全由于混杂因素引起的。(文章详见--BMJ:质子泵抑制剂对社区获得性肺炎的发生率的影响

【5】CHEST:治疗社区获得性肺炎,皮质类固醇的安全性和疗效性良好

皮质类固醇是在社区获得性肺炎(CAP)治疗的一种药物选择。然而,皮质类固醇的优势和不利影响,特别是在重症CAP中,没有得到很好的评估。

研究人员从成立到2015年5月全面检索了PubMed、EMBASE和Cochrane图书馆数据库中的随机对照试验(RCT)和队列研究,评估皮质类固醇对于成人CAP患者各个方面的效果。研究人员使用推荐评估、发展和评价方法分级评价结果的质量。随机效应模型Mantel-Haenszel法用于计算汇集相对危险度(RR)和95%可信区间。

研究人员对9项符合资格的RCTs(1667例患者)和6个队列研究(4095例患者)进行了鉴定。平均皮质类固醇的剂量和治疗的持续时间分别为甲泼尼龙30毫克/天,7天。对于CAP患者(RR,0.72;95%Cl,0.43-1.21;证据等级,低)和重症CAP患者(RCTs:RR,0.72;95%Cl,0.43-1.21;证据等级,低;队列研究:RR,1.00;95%CIl,0.86-1.17),皮质类固醇对死亡率没有显著的统计效果。使用皮质类固醇降低了急性呼吸窘迫综合征(ARDS)的风险(RR,0.21;95%Cl,0.08-0.59),并且可以减少住院和ICU,静脉抗生素治疗的持续时间,以及达到临床稳定的时间。皮质类固醇没有增加不良事件的发生率。

用皮质类固醇进行短期治疗是安全的,并且可以减少ARDS的风险,缩短CAP患者疾病的患病时间。(文章详见--CHEST:治疗社区获得性肺炎,皮质类固醇的安全性和疗效性良好

【6】JAMA Oncol:不同肿瘤和治疗方案下,PD-1抑制剂相关肺炎发生情况如何?

程序性细胞死亡1 (PD-1)抑制剂相关肺炎是一种罕见但严重、具有潜在生命威胁的不良事件。而目前不同肿瘤类型和治疗方案间的发生率是鲜为人知的。我们进行了研究,比较不同肿瘤类型和治疗方案间,PD-1抑制剂相关肺炎的发生率。

通过检索相关数据库,发现了26篇报告PD-1抑制剂相关肺炎的文献,纳入了20篇(共涉及4496例患者)关于黑色素瘤(n=12)、非小细胞肺癌(NSCLC;n=5)或肾细胞癌(RCC;n=3)的研究进行荟萃分析。研究以所有≥3级肺炎和肺炎相关死亡为主要终点。

多变量分析表明,与黑色素瘤相比,NSCLC患者的任何级别肺炎风险更高(OR 1.43; 95% CI, 1.08-1.89; P = .005),≥3级肺炎风险也更高(OR, 2.85; 95% CI, 1.60-5.08; P < .001);与黑色素瘤患者相比,RCC患者的任何级别肺炎风险更高(OR, 1.59; 95% CI, 1.32-1.92; P < .001)。联合治疗与单药治疗相比,任何级别肺炎风险更高(OR, 2.04; 95% CI, 1.69-2.50; P < .001),≥3级肺炎风险也更高(OR, 2.86; 95% CI, 1.79- 4.35; P < .001)。

结果表明,NSCLC和RCC患者,以及联合治疗过程中,PD-1抑制剂相关肺炎发生率更高。这些发现有助于提高临床医生的认识,并支持进一步的调查,以满足临床需求。(文章详见--JAMA Oncol:不同肿瘤和治疗方案下,PD-1抑制剂相关肺炎发生情况如何?

【7】PLoS One:A2DS2分数可预测中国缺血性卒中患者卒中相关肺炎和住院死亡

卒中相关性肺炎(SAP)是常见的并发症,并且也是住院期间死亡的重要原因之一。A2DS2(年龄、心房纤颤、吞咽困难、性别、卒中的严重程度)评分是柏林卒中注册开发,能够很好的预测SAP的发生。研究者旨在识别A2DS2评分和SAP之间的关联,并且确定A2DS2评分是否能预测中国人群急性缺血性卒中的死亡。


方法:研究者进行了一项回顾性的研究。将1239名急性缺血性脑卒中患者分为低A2DS2组(0-4)和高A2DS2评分(5-10)组。主要预后为住院卒中相关肺炎的发生,应用Logistic回归分析确定A2DS2评分和SAP之间的关联,以及A2DS2评分和住院死亡的相关性。

结果:急性缺血性卒中后,SAP和住院死亡率的总体发生率分别为7.3%和2.4%的。低SAP组和高A2DS2评分组卒中相关性肺炎的发生率分别为3.3%和24.7%(P<0.001)。在住院期间,1.2%低评分组的患者和7.8%高分组的患者死亡。多元回归分析显示,高评分组患者卒中相关肺炎(OR 8.888, 95%CI:5.552-14.229)和死亡(OR 7.833,95% CI:3.580-17.137)的发生风险高于低评分组的患者。

结论:A2DS2评分是中国急性缺血性患者,卒中相关性肺炎和住院死亡的强预测因子。A2DS2评分可能是预测住院期间发生SAP和死亡的有效评分。(文章详见--PLoS One:A2DS2分数可预测中国缺血性卒中患者卒中相关肺炎和住院死亡

【8】J Neurol Neurosurg Psychiatry: 卒中后早期评估和筛查吞咽困难,减少卒中相关肺炎的发生

没有强有力的证据表明,筛选急性卒中吞咽困难的患者降低卒中相关性肺炎(AIS)的风险,也没有证据表明,入院后什么时候进行筛选。研究者旨在确定延迟床边吞咽困难筛查,且延迟言语和语言治疗师(SALT)对综合性吞咽困难进行评估是否与患者发生SAP的风险相关。

这项全国范围内,以登记为基础的,前瞻性队列研究的受试者为英格兰和威尔士的急性卒中患者。
在承认在的急性中风。校正患者变量和卒中的严重程度,多层次多因素logistic回归模型进行拟合。暴露为(1)入院到床旁吞咽困难筛查的时间,和(2)入院到进行综合性吞咽困难评估的时间。

结果:收治63650例急性脑卒中,55 838(88%)进行吞咽困难的屏幕,和24 542(39%)进行综合性吞咽困难的评估。最长延迟的吞咽困难筛查(第四分位数校正OR 1.14,1.03至1.24)和SALT(第四分位数校正OR 2.01,1.76至2.30)的患者发生SAP的风险较高。延迟SALT吞咽困难评估与SAP发生的风险增加呈剂量-反应方式,每延迟一天,肺炎的发病率为1%。 

结论:卒中后延迟筛选和评估卒中后吞咽困难与SAP高风险相关。急性卒中后,SAP是死亡的主要原因之一,早期吞咽困难评估可能有助于防止急性卒中的死亡,即使在无高科技专家的卒中护理中也可以实施。(文章详见--J Neurol Neurosurg Psychiatry: 卒中后早期评估和筛查吞咽困难,减少卒中相关肺炎的发生

【9】Lancet:烹饪和肺炎有啥关系?

近日,顶级医学杂志Lancet上发表了一篇文章,研究人员假设,用清洁生物燃料替代明火炉灶将会降低儿童肺炎的发病率。 

研究人员进行了一项社区开放整群随机对照试验,来比较清洁生物燃料炉灶干预与继续使用明火炉灶对生活在马拉维两个地区Chikhwawa和Karonga的农村儿童肺炎的影响。使用计算机生成的随机数表与根据位置、到健康中心的距离、群体大小分层,将群体随机分配到干预组和对照组。在群体内,家里有4.5岁儿童的家庭有资格参加,发放给干预组家庭两个生物燃料的炉灶和一个太阳能电池板。主要结局为5岁以下的儿童发生WHO儿童疾病综合管理(IMCI)定义的肺炎情况。治疗意向性治疗用于进行疗效和安全性分析。该试验在ISRCTN进行注册,注册号为ISRCTN59448623。

研究者在2013年12月9日至2016年2月28日期间招募了来自150个群体8626户家庭的750名儿童。来自于8470户家庭的10,543名儿童为意向治疗分析提供了15,991名儿童/年的随访数据。干预组的IMCI肺炎发生率为每100名儿童15.76人/年(95%可信区间为14.89-16.63),对照组为100名儿童15.58人/年(95%可信区间为14.72-16.45),干预组比对照组发病率比值(IRR)为1.01(95%可信区间为0.91-1.13;P=0.80)。19名儿童出现了烹饪相关的严重不良事件(烧伤);干预组9名和对照组10名(1名死亡)(IRR为0.91[95%可信区间为0.37-2.23];P=0.83)。 

由此可见,我们没有发现任何证据表明干预包括清洁生物燃料炉灶能够减少了马拉维农村儿童肺炎的风险,但是有效的策略以减少家庭空气污染的不利健康影响是必要的。(文章详见--Lancet:烹饪和肺炎有啥关系?

【10】PLoS One:C反应蛋白可用于严重卒中患者早期诊断肺炎

由于体格检查困难,免疫状态改变,影像学表现延迟,使得卒中后合并肺炎的准确诊断受到挑战。本研究旨在描述卒中后肺炎早期的临床表现,并且检测C反应蛋白是否是卒中后肺炎的诊断标志物。

方法:研究包括进行鼻饲的患者及卒中7天内无肺炎证据的患者,随访21天,每天进行临床检查。根据英国胸部协会改良标准诊断肺炎的发生。

结果:招募60名患者(平均年龄77岁,平均NIHSS分数为19.47)。44例患者诊断为肺炎。肺炎诊断当天的常见表现为为新出现的裂纹(43 / 44,98%)、呼吸急促>25次/分(42/44、95%),血氧饱和度<90%(41 / 44,93%)。27例(61%)患者发生咳嗽,25(57%)患者咳脓痰,15(34%)发热>38°C。38例(86%)患者白细胞(白细胞>11000个/毫升)升高,和43(97%)肺炎患者CRP增高(>10 mg/L)。CRP的ROC曲线下面积为0.827(95%可信区间0.720,0.933)。可接受诊断敏感性(> 0.8)CRP的界值点为25.60 mg/L(Youden指数(J)0.515;灵敏度0.848;特异性0.667)。界值为64.65毫克/升时,诊断准确率最高(J 0.562,敏感性0.636,特异性0.926)。

结论:重症脑卒中患者发生肺部感染,在疾病早期不常表现咳嗽、咳脓痰,这些诊断肺炎的关键症状。本研究最常见的症状是新出现的裂纹,呼吸急促,缺氧。研究结果表明,CRP>25 mg/L时应及时观察肺炎的发生,而当CRP值>65 mg/L,则肺炎诊断的准确性已经较高。(文章详见--PLoS One:C反应蛋白可用于严重卒中患者早期诊断肺炎

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  1. [GetPortalCommentsPageByObjectIdResponse(id=173993, encodeId=fe161e3993ec, content=很好。, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161225/IMG585F3D3233DDB9743.jpg, createdBy=82cc2000289, createdName=07639, createdTime=Fri Feb 03 15:04:09 CST 2017, time=2017-02-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165372, encodeId=e6d41653e205, content=学习了!!!!!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160811/IMG57AC91915ACA64463.jpg, createdBy=9c351934462, createdName=知难而进, createdTime=Sat Dec 24 19:17:49 CST 2016, time=2016-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165268, encodeId=d28316526854, content=年终总结啦!, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=92191944782, createdName=thlabcde, createdTime=Sat Dec 24 07:06:14 CST 2016, time=2016-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165263, encodeId=5d7416526338, content=学习新知识谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Sat Dec 24 07:03:03 CST 2016, time=2016-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165204, encodeId=0b8a1652045a, content=哈哈,正好在呼吸科,很有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K4PNicOvbHfgIficrsEKztlD5yv1UnCFhnFmFU9yv1RHLflMRibWrppbsiccfMB8tT9HCkAr3zL2zVml/0, createdBy=89da1604922, createdName=䖝二, createdTime=Fri Dec 23 23:52:09 CST 2016, time=2016-12-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165202, encodeId=1bf2165202ad, content=呼吸科必备, beContent=null, objectType=article, channel=null, level=null, likeNumber=17, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKVkILniabnuT4anP3RF0Vej3wtdQkUBaoVQQnEtgRJuCA6d08SVmHylJsibr3ZOX3icakISxC61l5Aw/132, createdBy=bd3e1976218, createdName=aleale, createdTime=Fri Dec 23 23:50:30 CST 2016, time=2016-12-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165200, encodeId=33e116520080, content=疫苗有预防支原体肺炎的吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Fri Dec 23 23:32:31 CST 2016, time=2016-12-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165169, encodeId=5dde165169bf, content=好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1b591933728, createdName=1e0d6707m74(暂无匿称), createdTime=Fri Dec 23 16:57:41 CST 2016, time=2016-12-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165163, encodeId=a1ef165163d6, content=为了积分, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=15071676612, createdName=oistory, createdTime=Fri Dec 23 16:45:58 CST 2016, time=2016-12-23, status=1, ipAttribution=)]
    2017-02-03 07639

    很好。

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=173993, encodeId=fe161e3993ec, content=很好。, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161225/IMG585F3D3233DDB9743.jpg, createdBy=82cc2000289, createdName=07639, createdTime=Fri Feb 03 15:04:09 CST 2017, time=2017-02-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165372, encodeId=e6d41653e205, content=学习了!!!!!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160811/IMG57AC91915ACA64463.jpg, createdBy=9c351934462, createdName=知难而进, createdTime=Sat Dec 24 19:17:49 CST 2016, time=2016-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165268, encodeId=d28316526854, content=年终总结啦!, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=92191944782, createdName=thlabcde, createdTime=Sat Dec 24 07:06:14 CST 2016, time=2016-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165263, encodeId=5d7416526338, content=学习新知识谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Sat Dec 24 07:03:03 CST 2016, time=2016-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165204, encodeId=0b8a1652045a, content=哈哈,正好在呼吸科,很有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K4PNicOvbHfgIficrsEKztlD5yv1UnCFhnFmFU9yv1RHLflMRibWrppbsiccfMB8tT9HCkAr3zL2zVml/0, createdBy=89da1604922, createdName=䖝二, createdTime=Fri Dec 23 23:52:09 CST 2016, time=2016-12-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165202, encodeId=1bf2165202ad, content=呼吸科必备, beContent=null, objectType=article, channel=null, level=null, likeNumber=17, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKVkILniabnuT4anP3RF0Vej3wtdQkUBaoVQQnEtgRJuCA6d08SVmHylJsibr3ZOX3icakISxC61l5Aw/132, createdBy=bd3e1976218, createdName=aleale, createdTime=Fri Dec 23 23:50:30 CST 2016, time=2016-12-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165200, encodeId=33e116520080, content=疫苗有预防支原体肺炎的吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Fri Dec 23 23:32:31 CST 2016, time=2016-12-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165169, encodeId=5dde165169bf, content=好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1b591933728, createdName=1e0d6707m74(暂无匿称), createdTime=Fri Dec 23 16:57:41 CST 2016, time=2016-12-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165163, encodeId=a1ef165163d6, content=为了积分, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=15071676612, createdName=oistory, createdTime=Fri Dec 23 16:45:58 CST 2016, time=2016-12-23, status=1, ipAttribution=)]
    2016-12-24 知难而进

    学习了!!!!!!!

    0

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    2016-12-24 thlabcde

    年终总结啦!

    0

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    2016-12-24 刘煜

    学习新知识谢谢分享

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=173993, encodeId=fe161e3993ec, content=很好。, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161225/IMG585F3D3233DDB9743.jpg, createdBy=82cc2000289, createdName=07639, createdTime=Fri Feb 03 15:04:09 CST 2017, time=2017-02-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165372, encodeId=e6d41653e205, content=学习了!!!!!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160811/IMG57AC91915ACA64463.jpg, createdBy=9c351934462, createdName=知难而进, createdTime=Sat Dec 24 19:17:49 CST 2016, time=2016-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165268, encodeId=d28316526854, content=年终总结啦!, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=92191944782, createdName=thlabcde, createdTime=Sat Dec 24 07:06:14 CST 2016, time=2016-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165263, encodeId=5d7416526338, content=学习新知识谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Sat Dec 24 07:03:03 CST 2016, time=2016-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165204, encodeId=0b8a1652045a, content=哈哈,正好在呼吸科,很有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K4PNicOvbHfgIficrsEKztlD5yv1UnCFhnFmFU9yv1RHLflMRibWrppbsiccfMB8tT9HCkAr3zL2zVml/0, createdBy=89da1604922, createdName=䖝二, createdTime=Fri Dec 23 23:52:09 CST 2016, time=2016-12-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165202, encodeId=1bf2165202ad, content=呼吸科必备, beContent=null, objectType=article, channel=null, level=null, likeNumber=17, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKVkILniabnuT4anP3RF0Vej3wtdQkUBaoVQQnEtgRJuCA6d08SVmHylJsibr3ZOX3icakISxC61l5Aw/132, createdBy=bd3e1976218, createdName=aleale, createdTime=Fri Dec 23 23:50:30 CST 2016, time=2016-12-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165200, encodeId=33e116520080, content=疫苗有预防支原体肺炎的吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Fri Dec 23 23:32:31 CST 2016, time=2016-12-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165169, encodeId=5dde165169bf, content=好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1b591933728, createdName=1e0d6707m74(暂无匿称), createdTime=Fri Dec 23 16:57:41 CST 2016, time=2016-12-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165163, encodeId=a1ef165163d6, content=为了积分, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=15071676612, createdName=oistory, createdTime=Fri Dec 23 16:45:58 CST 2016, time=2016-12-23, status=1, ipAttribution=)]
    2016-12-23 䖝二

    哈哈,正好在呼吸科,很有用

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=173993, encodeId=fe161e3993ec, content=很好。, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161225/IMG585F3D3233DDB9743.jpg, createdBy=82cc2000289, createdName=07639, createdTime=Fri Feb 03 15:04:09 CST 2017, time=2017-02-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165372, encodeId=e6d41653e205, content=学习了!!!!!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160811/IMG57AC91915ACA64463.jpg, createdBy=9c351934462, createdName=知难而进, createdTime=Sat Dec 24 19:17:49 CST 2016, time=2016-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165268, encodeId=d28316526854, content=年终总结啦!, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=92191944782, createdName=thlabcde, createdTime=Sat Dec 24 07:06:14 CST 2016, time=2016-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165263, encodeId=5d7416526338, content=学习新知识谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Sat Dec 24 07:03:03 CST 2016, time=2016-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165204, encodeId=0b8a1652045a, content=哈哈,正好在呼吸科,很有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K4PNicOvbHfgIficrsEKztlD5yv1UnCFhnFmFU9yv1RHLflMRibWrppbsiccfMB8tT9HCkAr3zL2zVml/0, createdBy=89da1604922, createdName=䖝二, createdTime=Fri Dec 23 23:52:09 CST 2016, time=2016-12-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165202, encodeId=1bf2165202ad, content=呼吸科必备, beContent=null, objectType=article, channel=null, level=null, likeNumber=17, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKVkILniabnuT4anP3RF0Vej3wtdQkUBaoVQQnEtgRJuCA6d08SVmHylJsibr3ZOX3icakISxC61l5Aw/132, createdBy=bd3e1976218, createdName=aleale, createdTime=Fri Dec 23 23:50:30 CST 2016, time=2016-12-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165200, encodeId=33e116520080, content=疫苗有预防支原体肺炎的吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Fri Dec 23 23:32:31 CST 2016, time=2016-12-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165169, encodeId=5dde165169bf, content=好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1b591933728, createdName=1e0d6707m74(暂无匿称), createdTime=Fri Dec 23 16:57:41 CST 2016, time=2016-12-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165163, encodeId=a1ef165163d6, content=为了积分, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=15071676612, createdName=oistory, createdTime=Fri Dec 23 16:45:58 CST 2016, time=2016-12-23, status=1, ipAttribution=)]
    2016-12-23 aleale

    呼吸科必备

    0

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    2016-12-23 有备才能无患

    疫苗有预防支原体肺炎的吗

    0

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    2016-12-23 1e0d6707m74(暂无匿称)

    好!

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=173993, encodeId=fe161e3993ec, content=很好。, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161225/IMG585F3D3233DDB9743.jpg, createdBy=82cc2000289, createdName=07639, createdTime=Fri Feb 03 15:04:09 CST 2017, time=2017-02-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165372, encodeId=e6d41653e205, content=学习了!!!!!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160811/IMG57AC91915ACA64463.jpg, createdBy=9c351934462, createdName=知难而进, createdTime=Sat Dec 24 19:17:49 CST 2016, time=2016-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165268, encodeId=d28316526854, content=年终总结啦!, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=92191944782, createdName=thlabcde, createdTime=Sat Dec 24 07:06:14 CST 2016, time=2016-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165263, encodeId=5d7416526338, content=学习新知识谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Sat Dec 24 07:03:03 CST 2016, time=2016-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165204, encodeId=0b8a1652045a, content=哈哈,正好在呼吸科,很有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K4PNicOvbHfgIficrsEKztlD5yv1UnCFhnFmFU9yv1RHLflMRibWrppbsiccfMB8tT9HCkAr3zL2zVml/0, createdBy=89da1604922, createdName=䖝二, createdTime=Fri Dec 23 23:52:09 CST 2016, time=2016-12-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165202, encodeId=1bf2165202ad, content=呼吸科必备, beContent=null, objectType=article, channel=null, level=null, likeNumber=17, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKVkILniabnuT4anP3RF0Vej3wtdQkUBaoVQQnEtgRJuCA6d08SVmHylJsibr3ZOX3icakISxC61l5Aw/132, createdBy=bd3e1976218, createdName=aleale, createdTime=Fri Dec 23 23:50:30 CST 2016, time=2016-12-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165200, encodeId=33e116520080, content=疫苗有预防支原体肺炎的吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Fri Dec 23 23:32:31 CST 2016, time=2016-12-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165169, encodeId=5dde165169bf, content=好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1b591933728, createdName=1e0d6707m74(暂无匿称), createdTime=Fri Dec 23 16:57:41 CST 2016, time=2016-12-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=165163, encodeId=a1ef165163d6, content=为了积分, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=15071676612, createdName=oistory, createdTime=Fri Dec 23 16:45:58 CST 2016, time=2016-12-23, status=1, ipAttribution=)]
    2016-12-23 oistory

    为了积分

    0

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