ESC 2015：IMPROVE-IT亚组分析：糖尿病患者胆固醇“低一些更好”

2015-09-02 河北省人民医院郭艺芳郭艺芳微博

IMPROVE-IT研究是一项具有里程碑意义的临床试验，主要回答了两个备受关注的问题：1．应用非他汀类药物降低胆固醇水平能否获益？2．当LDL-C处于较低水平时继续降低其水平可否进一步获益？该研究结果对上述两个问题均做出了肯定性的回答，从而论证了两个理念：1．降胆固醇是硬道理；2．对于急性冠脉综合征（ACS）患者，胆固醇低一些更好。本届ESC年会期间报道的关于糖尿病患者的亚组分析则发现，联合应用依

IMPROVE-IT研究是一项具有里程碑意义的临床试验，主要回答了两个备受关注的问题：1．应用非他汀类药物降低胆固醇水平能否获益？2．当LDL-C处于较低水平时继续降低其水平可否进一步获益？该研究结果对上述两个问题均做出了肯定性的回答，从而论证了两个理念：1．降胆固醇是硬道理；2．对于急性冠脉综合征（ACS）患者，胆固醇低一些更好。本届ESC年会期间报道的关于糖尿病患者的亚组分析则发现，联合应用依折麦布与他汀能够更为显著的降低伴糖尿病的ACS患者的不良终点事件风险。提示胆固醇“低一些更好”的理念同样适于糖尿病患者。

一、IMPROVE-IT研究回顾

共纳入18144例急性冠状动脉综合征患者（基线LDL-C为2.46mmol/L），其中ST段抬高型心肌梗死5192例（基线LDL-C为2.6mmol/L），非ST段抬高型心肌梗死或不稳定性心绞痛12952例（基线LDL-C为2.4mmol/L）。将受试者随机分为两组，分别予以辛伐他汀（40mg/d）加安慰剂或辛伐他汀（40mg/d）加依折麦布治疗。辛伐他汀治疗组LDL-C的目标值为＜1.8mmol/L，预期辛伐他汀联合依折麦布组患者LDL-C可进一步降低0.4mmol/L（即达到1.4mmol/L）。主要终点为由心血管死亡、非致死性心肌梗死、因不稳定性心绞痛再次住院、冠状动脉血运重建所组成的复合终点。辛伐他汀组与辛伐他汀/依折麦布组患者中位数随访时间分别为6.0与5.9年。

结果显示，随访期间辛伐他汀组与辛伐他汀/依折麦布组患者平均LDL-C水平分别为1.8mmol/L（69.5mg/dl）与1.4mmol/L（53.7mg/dl），主要终点事件发生率分别为34.7％与32.7%（p=0.016），心肌梗死发生率分别为14.8％与13.1%（p=0.002），缺血性卒中发生率分别为4.1％与3.4%（p=0.008），心血管死亡/心肌梗死/卒中复合终点发生率分别为22.2％与20.4%（p=0.003）。两组间肝脏不良事件、肌肉不良事件以及癌症发生率均无显著差异。

本研究结果为“降胆固醇是硬道理”的理念提供了更多的临床研究证据，对最新美国成人降胆固醇治疗指南放弃LDL-C目标值的立场、以及英国血脂指南中唯他汀独尊的观点形成了挑战。此外，现行指南推荐急性冠状动脉综合征息者的LDL-C目标值为＜1.8mmol/L。本研究提示将LDL-C进一步降低至1.4mmol/L可使患者更多获益，因而支持胆固醇水平“低一些更好”的理念。

二、糖尿病亚组分析

本研究受试者中共有4933例（约27%）糖尿病患者。研究结束时，糖尿病患者与非糖尿病患者LDL-C降低幅度的中位值分别为0.98mmol/L与0.84mmol/L（p=0.03）。单独应用他汀治疗组或联合应用依折麦布和他汀治疗组的糖尿病患者主要终点事件发生率分别为45.5％与40.0%（HR 0.86，95%CI 0.78-0.94，p=0.023）；对心肌梗死和卒中等单个终点分析也显示糖尿病亚组受试者经过依折麦布联合他汀治疗后获益更为显著。

这一结果表明，无论急性冠脉综合征患者是否伴有糖尿病，胆固醇“低一些更好”的理念具有普适性，并且降胆固醇治疗可能是糖尿病患者更大幅度的获益。这一研究结论将进一步完善糖尿病患者的血脂异常管理策略。

三、LDL-C应该降到什么水平？

这个问题尚无答案，但肯定不是“越低越好”。“Lower is better”绝对不等同于“The lower the better”。胆固醇虽然是动脉粥样硬化病变的第一要素，但同时也是维持机体构建、组织修复以及多种激素形成和生理生化活动的重要物质，过度降低胆固醇水平可能会增加发生相关不良事件的风险。然而，迄今尚不清楚胆固醇的低限是多少。IMPROVE-IT研究提示，将LDL-C降低至1.4mmol/L是安全的。进一步降低的利弊如何，尚待探讨。

临床上经常遇到两个问题：

1、确诊冠心病的患者，若LDL-C水平已经在目标值（1.8mmol/l）以下，是否还需要使用他汀？

回答是肯定的，只要没有禁忌证，所有确诊动脉粥样硬化性心血管病（冠心病、缺血性卒中、外周动脉疾病）的患者均应接受他汀治疗。

2、LDL-C降低到什么水平需要考虑停药或减量？

这个问题没有明确答案。动脉粥样硬化性心血管病患者应长期服用他汀，即使LDL-C已经降低至目标值以下也不应停药。但若LDL-C低于1.0mmol/L，可以考虑适当减小他汀的用药剂量。

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好好看下！

178 0
[GetPortalCommentsPageByObjectIdResponse(id=73214, encodeId=6193e3214f1, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=120, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:43:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73204, encodeId=50dae320427, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73205, encodeId=6de4e32052a, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=178, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73206, encodeId=862ce32066d, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73207, encodeId=854de32079b, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=157, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73208, encodeId=4628e3208c7, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73209, encodeId=0686e320915, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73210, encodeId=8ce4e32103f, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73211, encodeId=584ae32111d, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73212, encodeId=89f7e321268, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=)]
2016-03-24 忠诚向上

好好看下！

119 0
[GetPortalCommentsPageByObjectIdResponse(id=73214, encodeId=6193e3214f1, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=120, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:43:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73204, encodeId=50dae320427, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73205, encodeId=6de4e32052a, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=178, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73206, encodeId=862ce32066d, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73207, encodeId=854de32079b, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=157, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73208, encodeId=4628e3208c7, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73209, encodeId=0686e320915, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73210, encodeId=8ce4e32103f, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73211, encodeId=584ae32111d, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73212, encodeId=89f7e321268, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=)]
2016-03-24 忠诚向上

好好看下！

157 0
[GetPortalCommentsPageByObjectIdResponse(id=73214, encodeId=6193e3214f1, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=120, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:43:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73204, encodeId=50dae320427, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73205, encodeId=6de4e32052a, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=178, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73206, encodeId=862ce32066d, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73207, encodeId=854de32079b, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=157, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73208, encodeId=4628e3208c7, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73209, encodeId=0686e320915, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73210, encodeId=8ce4e32103f, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73211, encodeId=584ae32111d, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73212, encodeId=89f7e321268, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=)]
2016-03-24 忠诚向上

好好看下！

82 0
[GetPortalCommentsPageByObjectIdResponse(id=73214, encodeId=6193e3214f1, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=120, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:43:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73204, encodeId=50dae320427, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73205, encodeId=6de4e32052a, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=178, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73206, encodeId=862ce32066d, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73207, encodeId=854de32079b, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=157, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73208, encodeId=4628e3208c7, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73209, encodeId=0686e320915, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73210, encodeId=8ce4e32103f, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73211, encodeId=584ae32111d, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73212, encodeId=89f7e321268, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=)]
2016-03-24 忠诚向上

好好看下！

96 0
[GetPortalCommentsPageByObjectIdResponse(id=73214, encodeId=6193e3214f1, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=120, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:43:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73204, encodeId=50dae320427, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73205, encodeId=6de4e32052a, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=178, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73206, encodeId=862ce32066d, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73207, encodeId=854de32079b, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=157, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73208, encodeId=4628e3208c7, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73209, encodeId=0686e320915, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73210, encodeId=8ce4e32103f, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73211, encodeId=584ae32111d, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73212, encodeId=89f7e321268, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=)]
2016-03-24 忠诚向上

好好看下！

82 0
[GetPortalCommentsPageByObjectIdResponse(id=73214, encodeId=6193e3214f1, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=120, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:43:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73204, encodeId=50dae320427, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73205, encodeId=6de4e32052a, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=178, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73206, encodeId=862ce32066d, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73207, encodeId=854de32079b, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=157, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73208, encodeId=4628e3208c7, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73209, encodeId=0686e320915, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73210, encodeId=8ce4e32103f, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73211, encodeId=584ae32111d, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73212, encodeId=89f7e321268, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=)]
2016-03-24 忠诚向上

好好看下！

42 0
[GetPortalCommentsPageByObjectIdResponse(id=73214, encodeId=6193e3214f1, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=120, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:43:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73204, encodeId=50dae320427, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73205, encodeId=6de4e32052a, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=178, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73206, encodeId=862ce32066d, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73207, encodeId=854de32079b, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=157, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73208, encodeId=4628e3208c7, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73209, encodeId=0686e320915, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73210, encodeId=8ce4e32103f, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73211, encodeId=584ae32111d, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=73212, encodeId=89f7e321268, content=好好看下！, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Thu Mar 24 07:42:00 CST 2016, time=2016-03-24, status=1, ipAttribution=)]
2016-03-24 忠诚向上

好好看下！

91 0

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