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EuroPCR 2015：双联抗血小板治疗时间到底延长还是缩短？

2015-05-29 中国医学科学院阜外医院 颜红兵 中国医学论坛报

EuroPCR双联抗血小板
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争鸣缘何而起？2015年欧洲血运重建大会（EuroPCR 2015）于5月19日在法国巴黎揭幕，开幕式后的重头戏是75分钟有关“日常实践中的双联抗血小板治疗（DAPT）”的辩论争鸣。其背景是过去5年先后发表了12项有关DAPT时间的研究结果，包括PRODIGY研究、EXCELLENT研究、OPTIMIZE研究、RESET研究、ITALIC研究、DES-LATE研究、ZEST-LATE研究、REAL



争鸣缘何而起？

2015年欧洲血运重建大会（EuroPCR 2015）于5月19日在法国巴黎揭幕，开幕式后的重头戏是75分钟有关“日常实践中的双联抗血小板治疗（DAPT）”的辩论争鸣。其背景是过去5年先后发表了12项有关DAPT时间的研究结果，包括PRODIGY研究、EXCELLENT研究、OPTIMIZE研究、RESET研究、ITALIC研究、DES-LATE研究、ZEST-LATE研究、REAL-LATE研究、ARCTIC-Interruption研究、DAPT研究、TL-PAS研究和Pegasus研究，以及2014年8月30日欧洲心脏病学会（ESC）与欧洲心胸外科学会（EACTS）在线发表的2014心肌血运重建治疗指南。

以4个病例为基础的讨论

这次“日常实践中的DAPT”争鸣是以4个病例为基础，分别假设了4种临床情况下的双联抗血小板治疗时间：①稳定的冠状动脉疾病，冠脉介入治疗效果良好；②非ST段抬高型心肌梗死，置入多个药物洗脱支架；③非ST段抬高型心肌梗死、高龄女性患者，低体重，肾功能受损；④急性冠脉综合征合并心房颤动。

临床研究证据回顾

回顾过去发表的相关研究，有5项重要研究支持缩短DAPT时间。2项是6个月DAPT与24个月DAPT比较，2项是3个月与12个月比较，1项是6个月与12个月比较。结果显示，3个月或6个月与12个月或24个月比较，主要终点事件没有显著性差异，而1项研究显示24个月DAPT增加出血事件。研究还显示，药物洗脱支架（DES）的种类和是否合并糖尿病，可能与包括支架内血栓在内的主要终点事件增加有关。

还有5项研究比较了12个月DAPT与16～30个月DAPT，2项研究显示延长DAPT时间并不降低主要终点，反而有增加心肌梗死、卒中或全因死亡率或出血的趋势。另2项研究显示延长DAPT可以降低包括支架内血栓在内的主要终点，但是其中1项研究提示增加出血，而另1项研究显示并不增加出血。

以患者为中心成为共识

这次辩论争鸣得到的基本共识是DAPT时间要以患者为中心。DAPT时间可以缩短为6个月的前提条件是：①应用新一代DES；②稳定性冠状动脉疾病择期PCI；③有发生出血的高风险。

延长DAPT可以减少冠状动脉血栓性事件的发生，但延长治疗并没有带来死亡率的降低。其中可能的原因包括：①延长DAPT增加出血事件；②入选患者的风险程度不一致，急性冠脉综合征（ACS）患者的血栓风险显著高于稳定性冠心病患者，这两类患者延长DAPT时间的获益可能存在差异；③终止DAPT后3个月血栓性事件均有升高，提示冠状动脉血栓性事件可能是动态的连续过程，现有临床研究DAPT时间可能远不能覆盖疾病的整个病程。

总之，临床实践中DAPT的最佳时间并不清楚，需要考虑冠状动脉疾病的性质（稳定性冠心病还是ACS）、支架种类（老一代DES还是新一代DES）、PCI的复杂性（简单手术还是复杂手术）和患者的具体风险（缺血与出血）来决策（即个体化治疗）。

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    2016-03-22 tomyang98

    #EuroPCR#

    0

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    2015-11-14 ms306040998833292

    #治疗时间#

    0

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    2016-02-02 tulenzi

    #双联抗血小板#

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1746868, encodeId=95e71e4686880, content=<a href='/topic/show?id=1fb7e08974' target=_blank style='color:#2F92EE;'>#EuroPCR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7089, encryptionId=1fb7e08974, topicName=EuroPCR)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4b4735868574, createdName=tomyang98, createdTime=Tue Mar 22 02:41:00 CST 2016, time=2016-03-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1992645, encodeId=cd0919926458b, content=<a href='/topic/show?id=f68c6465315' target=_blank style='color:#2F92EE;'>#治疗时间#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64653, encryptionId=f68c6465315, topicName=治疗时间)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/6F20312C71B4B22F603078C6DCFA72CE/100, createdBy=d3572500071, createdName=ms306040998833292, createdTime=Sat Nov 14 14:41:00 CST 2015, time=2015-11-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2009514, encodeId=c87920095141b, content=<a href='/topic/show?id=4f133e56590' target=_blank style='color:#2F92EE;'>#双联抗血小板#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37565, encryptionId=4f133e56590, topicName=双联抗血小板)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Tue Feb 02 19:41:00 CST 2016, time=2016-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=29764, encodeId=251a29e6435, content=亚组分析, beContent=null, objectType=article, channel=null, level=null, likeNumber=128, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b2c1627329, createdName=owlhealth, createdTime=Sun Jun 28 10:01:00 CST 2015, time=2015-06-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=25545, encodeId=88c025545f1, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=170, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Sun May 31 21:06:00 CST 2015, time=2015-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1419368, encodeId=505914193681b, content=<a href='/topic/show?id=e290138682e' target=_blank style='color:#2F92EE;'>#PCR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13868, encryptionId=e290138682e, topicName=PCR)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9cc43496966, createdName=Tommy1950, createdTime=Sat May 30 23:41:00 CST 2015, time=2015-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1515592, encodeId=61801515592a1, content=<a href='/topic/show?id=59ab3e5660f' target=_blank style='color:#2F92EE;'>#双联抗血小板治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37566, encryptionId=59ab3e5660f, topicName=双联抗血小板治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=af9010842042, createdName=12498bf3m28暂无昵称, createdTime=Sat May 30 23:41:00 CST 2015, time=2015-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=25363, encodeId=585525363c2, content=在不同的人群中，可能应该有不同疗程，半年一年还是更长时间应该个体化决策, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4a5105539, createdName=lovetcm, createdTime=Sat May 30 08:18:00 CST 2015, time=2015-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=25356, encodeId=2ebc2535658, content=要长, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=hbwang006, createdTime=Sat May 30 06:29:00 CST 2015, time=2015-05-30, status=1, ipAttribution=)]
    2015-06-28 owlhealth

    亚组分析

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1746868, encodeId=95e71e4686880, content=<a href='/topic/show?id=1fb7e08974' target=_blank style='color:#2F92EE;'>#EuroPCR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7089, encryptionId=1fb7e08974, topicName=EuroPCR)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4b4735868574, createdName=tomyang98, createdTime=Tue Mar 22 02:41:00 CST 2016, time=2016-03-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1992645, encodeId=cd0919926458b, content=<a href='/topic/show?id=f68c6465315' target=_blank style='color:#2F92EE;'>#治疗时间#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64653, encryptionId=f68c6465315, topicName=治疗时间)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/6F20312C71B4B22F603078C6DCFA72CE/100, createdBy=d3572500071, createdName=ms306040998833292, createdTime=Sat Nov 14 14:41:00 CST 2015, time=2015-11-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2009514, encodeId=c87920095141b, content=<a href='/topic/show?id=4f133e56590' target=_blank style='color:#2F92EE;'>#双联抗血小板#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37565, encryptionId=4f133e56590, topicName=双联抗血小板)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Tue Feb 02 19:41:00 CST 2016, time=2016-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=29764, encodeId=251a29e6435, content=亚组分析, beContent=null, objectType=article, channel=null, level=null, likeNumber=128, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b2c1627329, createdName=owlhealth, createdTime=Sun Jun 28 10:01:00 CST 2015, time=2015-06-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=25545, encodeId=88c025545f1, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=170, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Sun May 31 21:06:00 CST 2015, time=2015-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1419368, encodeId=505914193681b, content=<a href='/topic/show?id=e290138682e' target=_blank style='color:#2F92EE;'>#PCR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13868, encryptionId=e290138682e, topicName=PCR)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9cc43496966, createdName=Tommy1950, createdTime=Sat May 30 23:41:00 CST 2015, time=2015-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1515592, encodeId=61801515592a1, content=<a href='/topic/show?id=59ab3e5660f' target=_blank style='color:#2F92EE;'>#双联抗血小板治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37566, encryptionId=59ab3e5660f, topicName=双联抗血小板治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=af9010842042, createdName=12498bf3m28暂无昵称, createdTime=Sat May 30 23:41:00 CST 2015, time=2015-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=25363, encodeId=585525363c2, content=在不同的人群中，可能应该有不同疗程，半年一年还是更长时间应该个体化决策, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4a5105539, createdName=lovetcm, createdTime=Sat May 30 08:18:00 CST 2015, time=2015-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=25356, encodeId=2ebc2535658, content=要长, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=hbwang006, createdTime=Sat May 30 06:29:00 CST 2015, time=2015-05-30, status=1, ipAttribution=)]
    2015-05-31 huaxipanxing

    看看

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1746868, encodeId=95e71e4686880, content=<a href='/topic/show?id=1fb7e08974' target=_blank style='color:#2F92EE;'>#EuroPCR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7089, encryptionId=1fb7e08974, topicName=EuroPCR)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4b4735868574, createdName=tomyang98, createdTime=Tue Mar 22 02:41:00 CST 2016, time=2016-03-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1992645, encodeId=cd0919926458b, content=<a href='/topic/show?id=f68c6465315' target=_blank style='color:#2F92EE;'>#治疗时间#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64653, encryptionId=f68c6465315, topicName=治疗时间)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/6F20312C71B4B22F603078C6DCFA72CE/100, createdBy=d3572500071, createdName=ms306040998833292, createdTime=Sat Nov 14 14:41:00 CST 2015, time=2015-11-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2009514, encodeId=c87920095141b, content=<a href='/topic/show?id=4f133e56590' target=_blank style='color:#2F92EE;'>#双联抗血小板#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37565, encryptionId=4f133e56590, topicName=双联抗血小板)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Tue Feb 02 19:41:00 CST 2016, time=2016-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=29764, encodeId=251a29e6435, content=亚组分析, beContent=null, objectType=article, channel=null, level=null, likeNumber=128, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b2c1627329, createdName=owlhealth, createdTime=Sun Jun 28 10:01:00 CST 2015, time=2015-06-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=25545, encodeId=88c025545f1, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=170, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Sun May 31 21:06:00 CST 2015, time=2015-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1419368, encodeId=505914193681b, content=<a href='/topic/show?id=e290138682e' target=_blank style='color:#2F92EE;'>#PCR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13868, encryptionId=e290138682e, topicName=PCR)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9cc43496966, createdName=Tommy1950, createdTime=Sat May 30 23:41:00 CST 2015, time=2015-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1515592, encodeId=61801515592a1, content=<a href='/topic/show?id=59ab3e5660f' target=_blank style='color:#2F92EE;'>#双联抗血小板治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37566, encryptionId=59ab3e5660f, topicName=双联抗血小板治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=af9010842042, createdName=12498bf3m28暂无昵称, createdTime=Sat May 30 23:41:00 CST 2015, time=2015-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=25363, encodeId=585525363c2, content=在不同的人群中，可能应该有不同疗程，半年一年还是更长时间应该个体化决策, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4a5105539, createdName=lovetcm, createdTime=Sat May 30 08:18:00 CST 2015, time=2015-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=25356, encodeId=2ebc2535658, content=要长, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=hbwang006, createdTime=Sat May 30 06:29:00 CST 2015, time=2015-05-30, status=1, ipAttribution=)]
    2015-05-30 Tommy1950

    #PCR#

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1746868, encodeId=95e71e4686880, content=<a href='/topic/show?id=1fb7e08974' target=_blank style='color:#2F92EE;'>#EuroPCR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7089, encryptionId=1fb7e08974, topicName=EuroPCR)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4b4735868574, createdName=tomyang98, createdTime=Tue Mar 22 02:41:00 CST 2016, time=2016-03-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1992645, encodeId=cd0919926458b, content=<a href='/topic/show?id=f68c6465315' target=_blank style='color:#2F92EE;'>#治疗时间#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64653, encryptionId=f68c6465315, topicName=治疗时间)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/6F20312C71B4B22F603078C6DCFA72CE/100, createdBy=d3572500071, createdName=ms306040998833292, createdTime=Sat Nov 14 14:41:00 CST 2015, time=2015-11-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2009514, encodeId=c87920095141b, content=<a href='/topic/show?id=4f133e56590' target=_blank style='color:#2F92EE;'>#双联抗血小板#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37565, encryptionId=4f133e56590, topicName=双联抗血小板)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Tue Feb 02 19:41:00 CST 2016, time=2016-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=29764, encodeId=251a29e6435, content=亚组分析, beContent=null, objectType=article, channel=null, level=null, likeNumber=128, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b2c1627329, createdName=owlhealth, createdTime=Sun Jun 28 10:01:00 CST 2015, time=2015-06-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=25545, encodeId=88c025545f1, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=170, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Sun May 31 21:06:00 CST 2015, time=2015-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1419368, encodeId=505914193681b, content=<a href='/topic/show?id=e290138682e' target=_blank style='color:#2F92EE;'>#PCR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13868, encryptionId=e290138682e, topicName=PCR)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9cc43496966, createdName=Tommy1950, createdTime=Sat May 30 23:41:00 CST 2015, time=2015-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1515592, encodeId=61801515592a1, content=<a href='/topic/show?id=59ab3e5660f' target=_blank style='color:#2F92EE;'>#双联抗血小板治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37566, encryptionId=59ab3e5660f, topicName=双联抗血小板治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=af9010842042, createdName=12498bf3m28暂无昵称, createdTime=Sat May 30 23:41:00 CST 2015, time=2015-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=25363, encodeId=585525363c2, content=在不同的人群中，可能应该有不同疗程，半年一年还是更长时间应该个体化决策, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4a5105539, createdName=lovetcm, createdTime=Sat May 30 08:18:00 CST 2015, time=2015-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=25356, encodeId=2ebc2535658, content=要长, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=hbwang006, createdTime=Sat May 30 06:29:00 CST 2015, time=2015-05-30, status=1, ipAttribution=)]
    2015-05-30 12498bf3m28暂无昵称

    #双联抗血小板治疗#

    0

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    2015-05-30 lovetcm

    在不同的人群中，可能应该有不同疗程，半年一年还是更长时间应该个体化决策

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=1746868, encodeId=95e71e4686880, content=<a href='/topic/show?id=1fb7e08974' target=_blank style='color:#2F92EE;'>#EuroPCR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7089, encryptionId=1fb7e08974, topicName=EuroPCR)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4b4735868574, createdName=tomyang98, createdTime=Tue Mar 22 02:41:00 CST 2016, time=2016-03-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1992645, encodeId=cd0919926458b, content=<a href='/topic/show?id=f68c6465315' target=_blank style='color:#2F92EE;'>#治疗时间#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64653, encryptionId=f68c6465315, topicName=治疗时间)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/6F20312C71B4B22F603078C6DCFA72CE/100, createdBy=d3572500071, createdName=ms306040998833292, createdTime=Sat Nov 14 14:41:00 CST 2015, time=2015-11-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2009514, encodeId=c87920095141b, content=<a href='/topic/show?id=4f133e56590' target=_blank style='color:#2F92EE;'>#双联抗血小板#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37565, encryptionId=4f133e56590, topicName=双联抗血小板)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Tue Feb 02 19:41:00 CST 2016, time=2016-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=29764, encodeId=251a29e6435, content=亚组分析, beContent=null, objectType=article, channel=null, level=null, likeNumber=128, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b2c1627329, createdName=owlhealth, createdTime=Sun Jun 28 10:01:00 CST 2015, time=2015-06-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=25545, encodeId=88c025545f1, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=170, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Sun May 31 21:06:00 CST 2015, time=2015-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1419368, encodeId=505914193681b, content=<a href='/topic/show?id=e290138682e' target=_blank style='color:#2F92EE;'>#PCR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13868, encryptionId=e290138682e, topicName=PCR)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9cc43496966, createdName=Tommy1950, createdTime=Sat May 30 23:41:00 CST 2015, time=2015-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1515592, encodeId=61801515592a1, content=<a href='/topic/show?id=59ab3e5660f' target=_blank style='color:#2F92EE;'>#双联抗血小板治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37566, encryptionId=59ab3e5660f, topicName=双联抗血小板治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=af9010842042, createdName=12498bf3m28暂无昵称, createdTime=Sat May 30 23:41:00 CST 2015, time=2015-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=25363, encodeId=585525363c2, content=在不同的人群中，可能应该有不同疗程，半年一年还是更长时间应该个体化决策, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4a5105539, createdName=lovetcm, createdTime=Sat May 30 08:18:00 CST 2015, time=2015-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=25356, encodeId=2ebc2535658, content=要长, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=hbwang006, createdTime=Sat May 30 06:29:00 CST 2015, time=2015-05-30, status=1, ipAttribution=)]
    2015-05-30 hbwang006

    要长

    0

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