Diabetes Care:DCCT/EDIC研究,心血管自主神经病变能预测心血管疾病吗?

2016-12-13 赛诺菲医学部 菲糖新动

导语:自主神经支配是调节心率和心肌收缩力的主要外周控制途径,而心血管自主神经病变(CAN)已被证实是1型和2型糖尿病心血管疾病(CVD)死亡率的独立预测因子。2016年11月1日Diabetes Care在线发表了DCCT/EDIC研究的一项相关结果,主要目的是评估CAN是否是CVD事件的独立危险因素。CVD死亡仍是1型糖尿病(T1DM)患者死亡率高的主要原因,糖尿病控制与并发症研究(DCCT)/

导语:自主神经支配是调节心率和心肌收缩力的主要外周控制途径,而心血管自主神经病变(CAN)已被证实是1型和2型糖尿病心血管疾病(CVD)死亡率的独立预测因子。2016年11月1日Diabetes Care在线发表了DCCT/EDIC研究的一项相关结果,主要目的是评估CAN是否是CVD事件的独立危险因素。

CVD死亡仍是1型糖尿病(T1DM)患者死亡率高的主要原因,糖尿病控制与并发症研究(DCCT)/糖尿病干预与并发症流行病学研究(EDIC)显示,疾病早期进行强化降糖治疗可大幅降低CVD风险,但DCCT/EDIC研究期间的CVD事件发生率仍高于一般人群,提示存在其他影响CVD事件风险的因素。此外,DCCT/EDIC研究还显示,CAN对心脏重塑存在不利影响。

DCCT研究纳入1,441例病程1-25年的T1DM患者,随机接受强化治疗或常规治疗,平均治疗6.5年。DCCT结束后,1,394例患者进入EDIC随访研究,并跟踪了近20年。研究期间,通过心血管自主神经反射试验(限速呼吸R-R间期变化、瓦氏比值和卧立位血压变化)进行标准化CAN评估。DCCT研究于基线、研究期间(每两年评估一次)、研究结束时进行评估,EDIC研究于第13/14年、16/17年进行评估。采用Cox比例风险模型计算DCCT结束时存在CAN对EDIC研究期间CVD风险的影响。

与DCCT结束时无CAN的患者相比,存在CAN的患者在EDIC期间的首次CVD事件累积发生率更高

DCCT研究结束时的1,262例未发生CAN患者中,有132例(10.5%)于EDIC期间发生CVD事件;DCCT研究结束时的131例发生CAN患者中,33例(25.2%)于EDIC期间发生CVD事件。

DCCT研究结束时发生CAN的患者,EDIC期间任何首次CVD事件的累积发生率显著高于DCCT研究结束时未发生CAN的患者(P<0.0001)。

DCCT结束时有/无CAN的患者
在EDIC期间CVD事件累积发生率比较


校正DCCT期间年龄、治疗组、一级预防 vs. 二级干预队列、糖尿病病程、收缩压、舒张压、总胆固醇、甘油三酯和微量蛋白尿以及EDIC期间的HbA1c水平后,之前存在CAN与发生CVD风险的相关性减弱,但仍有统计学意义(HR 1.53,P=0.0474)。

发生CVD者限速呼吸R-R间期变化更小

与未发生CVD的患者相比,发生CVD的患者在DCCT研究结束时的限速呼吸R-R间期变化更小(34.4±20.4 vs.40.6±20.3,P<0.0001)。
 
尽管相对于HbA1c对CVD风险的影响而言,CAN不是CVD事件的独立预测因素,但本研究显示,DCCT研究结束时确诊存在CAN与随后CVD事件发生率增加相关。因此对CAN的诊断可帮助识别随时间进展具有高CVD风险的T1DM患者人群。

作者见解

1.血糖控制水平是CVD事件的影响因素 

DCCT/EDIC研究小组曾报道了血糖控制对预防随后CVD事件的获益,即“代谢记忆”。且近期报道显示,血糖控制与CVD事件之间有较强的相关性,表明除年龄外,平均HbA1c随时间的变化是临床CVD事件最强危险因素。在对血糖控制水平进行校正后,CAN与CVD风险之间的相关性减弱。

2.CAN与T1DM患者死亡率增加相关

荟萃分析显示,伴CAN的T1DM或T2DM患者死亡的相对风险为3.45(95%CI 2.66-4.47)。此外,EURODIAB前瞻性并发症研究显示,CAN是T1DM患者7年随访期间死亡的最强预测因素,远超其他传统心血管危险因素。本研究中死亡报道较少,故无法进行危险因素分析,但上述数据与本研究中存在CAN患者死亡率增加的结果一致。

原始出处:

Pop-Busui R1, Braffett BH2, Zinman B3, Martin C4, White NH5, Herman WH4, Genuth S6, Gubitosi-Klug R6; DCCT/EDIC Research Group.Cardiovascular Autonomic Neuropathy and Cardiovascular Outcomes in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study.Diabetes Care. 2016 Nov 1

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    2017-01-31 jeanqiuqiu
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  4. [GetPortalCommentsPageByObjectIdResponse(id=1901512, encodeId=28f61901512f8, content=<a href='/topic/show?id=c097591ed5' target=_blank style='color:#2F92EE;'>#Diabetes#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5917, encryptionId=c097591ed5, topicName=Diabetes)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0045169, createdName=木头人513, createdTime=Thu Jun 01 08:50:00 CST 2017, time=2017-06-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1858703, encodeId=03ac1858e03bc, content=<a href='/topic/show?id=e0a9593596' target=_blank style='color:#2F92EE;'>#DIC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5935, encryptionId=e0a9593596, topicName=DIC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6f7770, createdName=jeanqiuqiu, createdTime=Tue Jan 31 02:50:00 CST 2017, time=2017-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1637560, encodeId=c225163e560a7, content=<a href='/topic/show?id=afda591646' target=_blank style='color:#2F92EE;'>#DIA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5916, encryptionId=afda591646, topicName=DIA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=987022654425, createdName=ms9608593228839890, createdTime=Thu Oct 05 21:50:00 CST 2017, time=2017-10-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1968085, encodeId=1c51196808508, content=<a href='/topic/show?id=6d20424203' target=_blank style='color:#2F92EE;'>#CCT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4242, encryptionId=6d20424203, topicName=CCT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fd34186, createdName=wshxjq, createdTime=Fri Jun 16 14:50:00 CST 2017, time=2017-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1759827, encodeId=4db01e5982748, content=<a href='/topic/show?id=9bea33520d' target=_blank style='color:#2F92EE;'>#BET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3352, encryptionId=9bea33520d, topicName=BET)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9a1a37427546, createdName=ms5439512287675881, createdTime=Sat Jun 17 00:50:00 CST 2017, time=2017-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1491247, encodeId=c108149124e88, content=<a href='/topic/show?id=5316e4387aa' target=_blank style='color:#2F92EE;'>#神经病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74387, encryptionId=5316e4387aa, topicName=神经病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1ab48885684, createdName=axin012, createdTime=Thu Dec 15 08:50:00 CST 2016, time=2016-12-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1498101, encodeId=de83149810162, content=<a href='/topic/show?id=bb6f89e145a' target=_blank style='color:#2F92EE;'>#血管疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89714, encryptionId=bb6f89e145a, topicName=血管疾病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ccb99370406, createdName=andy2090, createdTime=Thu Dec 15 08:50:00 CST 2016, time=2016-12-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1500333, encodeId=88c6150033300, content=<a href='/topic/show?id=ecdfe438970' target=_blank style='color:#2F92EE;'>#神经病变#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74389, encryptionId=ecdfe438970, topicName=神经病变)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0ea69427176, createdName=lingaifan, createdTime=Thu Dec 15 08:50:00 CST 2016, time=2016-12-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=162542, encodeId=b447162542ff, content=值得研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=62d381629, createdName=yafeiliutjh, createdTime=Tue Dec 13 20:39:33 CST 2016, time=2016-12-13, status=1, ipAttribution=)]
    2017-06-16 wshxjq
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    2016-12-15 axin012
  7. [GetPortalCommentsPageByObjectIdResponse(id=1901512, encodeId=28f61901512f8, content=<a href='/topic/show?id=c097591ed5' target=_blank style='color:#2F92EE;'>#Diabetes#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5917, encryptionId=c097591ed5, topicName=Diabetes)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0045169, createdName=木头人513, createdTime=Thu Jun 01 08:50:00 CST 2017, time=2017-06-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1858703, encodeId=03ac1858e03bc, content=<a href='/topic/show?id=e0a9593596' target=_blank style='color:#2F92EE;'>#DIC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5935, encryptionId=e0a9593596, topicName=DIC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6f7770, createdName=jeanqiuqiu, createdTime=Tue Jan 31 02:50:00 CST 2017, time=2017-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1637560, encodeId=c225163e560a7, content=<a href='/topic/show?id=afda591646' target=_blank style='color:#2F92EE;'>#DIA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5916, encryptionId=afda591646, topicName=DIA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=987022654425, createdName=ms9608593228839890, createdTime=Thu Oct 05 21:50:00 CST 2017, time=2017-10-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1968085, encodeId=1c51196808508, content=<a href='/topic/show?id=6d20424203' target=_blank style='color:#2F92EE;'>#CCT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4242, encryptionId=6d20424203, topicName=CCT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fd34186, createdName=wshxjq, createdTime=Fri Jun 16 14:50:00 CST 2017, time=2017-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1759827, encodeId=4db01e5982748, content=<a href='/topic/show?id=9bea33520d' target=_blank style='color:#2F92EE;'>#BET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3352, encryptionId=9bea33520d, topicName=BET)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9a1a37427546, createdName=ms5439512287675881, createdTime=Sat Jun 17 00:50:00 CST 2017, time=2017-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1491247, encodeId=c108149124e88, content=<a href='/topic/show?id=5316e4387aa' target=_blank style='color:#2F92EE;'>#神经病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74387, encryptionId=5316e4387aa, topicName=神经病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1ab48885684, createdName=axin012, createdTime=Thu Dec 15 08:50:00 CST 2016, time=2016-12-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1498101, encodeId=de83149810162, content=<a href='/topic/show?id=bb6f89e145a' target=_blank style='color:#2F92EE;'>#血管疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89714, encryptionId=bb6f89e145a, topicName=血管疾病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ccb99370406, createdName=andy2090, createdTime=Thu Dec 15 08:50:00 CST 2016, time=2016-12-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1500333, encodeId=88c6150033300, content=<a href='/topic/show?id=ecdfe438970' target=_blank style='color:#2F92EE;'>#神经病变#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74389, encryptionId=ecdfe438970, topicName=神经病变)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0ea69427176, createdName=lingaifan, createdTime=Thu Dec 15 08:50:00 CST 2016, time=2016-12-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=162542, encodeId=b447162542ff, content=值得研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=62d381629, createdName=yafeiliutjh, createdTime=Tue Dec 13 20:39:33 CST 2016, time=2016-12-13, status=1, ipAttribution=)]
  8. [GetPortalCommentsPageByObjectIdResponse(id=1901512, encodeId=28f61901512f8, content=<a href='/topic/show?id=c097591ed5' target=_blank style='color:#2F92EE;'>#Diabetes#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5917, encryptionId=c097591ed5, topicName=Diabetes)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0045169, createdName=木头人513, createdTime=Thu Jun 01 08:50:00 CST 2017, time=2017-06-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1858703, encodeId=03ac1858e03bc, content=<a href='/topic/show?id=e0a9593596' target=_blank style='color:#2F92EE;'>#DIC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5935, encryptionId=e0a9593596, topicName=DIC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6f7770, createdName=jeanqiuqiu, createdTime=Tue Jan 31 02:50:00 CST 2017, time=2017-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1637560, encodeId=c225163e560a7, content=<a href='/topic/show?id=afda591646' target=_blank style='color:#2F92EE;'>#DIA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5916, encryptionId=afda591646, topicName=DIA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=987022654425, createdName=ms9608593228839890, createdTime=Thu Oct 05 21:50:00 CST 2017, time=2017-10-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1968085, encodeId=1c51196808508, content=<a href='/topic/show?id=6d20424203' target=_blank style='color:#2F92EE;'>#CCT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4242, encryptionId=6d20424203, topicName=CCT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fd34186, createdName=wshxjq, createdTime=Fri Jun 16 14:50:00 CST 2017, time=2017-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1759827, encodeId=4db01e5982748, content=<a href='/topic/show?id=9bea33520d' target=_blank style='color:#2F92EE;'>#BET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3352, encryptionId=9bea33520d, topicName=BET)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9a1a37427546, createdName=ms5439512287675881, createdTime=Sat Jun 17 00:50:00 CST 2017, time=2017-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1491247, encodeId=c108149124e88, content=<a href='/topic/show?id=5316e4387aa' target=_blank style='color:#2F92EE;'>#神经病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74387, encryptionId=5316e4387aa, topicName=神经病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1ab48885684, createdName=axin012, createdTime=Thu Dec 15 08:50:00 CST 2016, time=2016-12-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1498101, encodeId=de83149810162, content=<a href='/topic/show?id=bb6f89e145a' target=_blank style='color:#2F92EE;'>#血管疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89714, encryptionId=bb6f89e145a, topicName=血管疾病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ccb99370406, createdName=andy2090, createdTime=Thu Dec 15 08:50:00 CST 2016, time=2016-12-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1500333, encodeId=88c6150033300, content=<a href='/topic/show?id=ecdfe438970' target=_blank style='color:#2F92EE;'>#神经病变#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74389, encryptionId=ecdfe438970, topicName=神经病变)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0ea69427176, createdName=lingaifan, createdTime=Thu Dec 15 08:50:00 CST 2016, time=2016-12-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=162542, encodeId=b447162542ff, content=值得研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=62d381629, createdName=yafeiliutjh, createdTime=Tue Dec 13 20:39:33 CST 2016, time=2016-12-13, status=1, ipAttribution=)]
  9. [GetPortalCommentsPageByObjectIdResponse(id=1901512, encodeId=28f61901512f8, content=<a href='/topic/show?id=c097591ed5' target=_blank style='color:#2F92EE;'>#Diabetes#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5917, encryptionId=c097591ed5, topicName=Diabetes)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0045169, createdName=木头人513, createdTime=Thu Jun 01 08:50:00 CST 2017, time=2017-06-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1858703, encodeId=03ac1858e03bc, content=<a href='/topic/show?id=e0a9593596' target=_blank style='color:#2F92EE;'>#DIC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5935, encryptionId=e0a9593596, topicName=DIC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6f7770, createdName=jeanqiuqiu, createdTime=Tue Jan 31 02:50:00 CST 2017, time=2017-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1637560, encodeId=c225163e560a7, content=<a href='/topic/show?id=afda591646' target=_blank style='color:#2F92EE;'>#DIA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5916, encryptionId=afda591646, topicName=DIA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=987022654425, createdName=ms9608593228839890, createdTime=Thu Oct 05 21:50:00 CST 2017, time=2017-10-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1968085, encodeId=1c51196808508, content=<a href='/topic/show?id=6d20424203' target=_blank style='color:#2F92EE;'>#CCT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4242, encryptionId=6d20424203, topicName=CCT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fd34186, createdName=wshxjq, createdTime=Fri Jun 16 14:50:00 CST 2017, time=2017-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1759827, encodeId=4db01e5982748, content=<a href='/topic/show?id=9bea33520d' target=_blank style='color:#2F92EE;'>#BET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3352, encryptionId=9bea33520d, topicName=BET)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9a1a37427546, createdName=ms5439512287675881, createdTime=Sat Jun 17 00:50:00 CST 2017, time=2017-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1491247, encodeId=c108149124e88, content=<a href='/topic/show?id=5316e4387aa' target=_blank style='color:#2F92EE;'>#神经病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74387, encryptionId=5316e4387aa, topicName=神经病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1ab48885684, createdName=axin012, createdTime=Thu Dec 15 08:50:00 CST 2016, time=2016-12-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1498101, encodeId=de83149810162, content=<a href='/topic/show?id=bb6f89e145a' target=_blank style='color:#2F92EE;'>#血管疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89714, encryptionId=bb6f89e145a, topicName=血管疾病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ccb99370406, createdName=andy2090, createdTime=Thu Dec 15 08:50:00 CST 2016, time=2016-12-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1500333, encodeId=88c6150033300, content=<a href='/topic/show?id=ecdfe438970' target=_blank style='color:#2F92EE;'>#神经病变#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74389, encryptionId=ecdfe438970, topicName=神经病变)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0ea69427176, createdName=lingaifan, createdTime=Thu Dec 15 08:50:00 CST 2016, time=2016-12-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=162542, encodeId=b447162542ff, content=值得研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=62d381629, createdName=yafeiliutjh, createdTime=Tue Dec 13 20:39:33 CST 2016, time=2016-12-13, status=1, ipAttribution=)]
    2016-12-13 yafeiliutjh

    值得研究

    0

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