母乳喂养好!密集哺乳更好!可通过改善脂质代谢降低GDM女性T2DM风险!

2021-10-13 MedSci原创 MedSci原创

SWIFT研究:近期有妊娠糖尿病的妇女密集哺乳可显著改变产后早期循环脂质谱

世界卫生组织(WTO)建议,在分娩后头6个月内坚持用母乳喂养婴儿,能使产妇和婴儿健康获益,包括降低婴儿发病率和死亡率,预防乳腺癌卵巢癌,以及降低母亲未来的糖尿病和其他血管疾病风险。尽管如此,在大多数国家,6个月以下婴儿的母乳喂养率仍然远低于50%。 

有妊娠期糖尿病(GDM)病史的妇女患2型糖尿病(T2D)的风险要高7倍。据估计,20-50%有GDM历史的妇女将在分娩后10年内进入T2D。GDM妇女、婴儿喂养和 2 型糖尿病(SWIFT)研究发现,2个月或更长时间的密集哺乳和持续时间增加与 GDM 妊娠后 2 年 T2D 发病率的相对风险降低 34-57% 有关。密集哺乳与降低T2D事件风险之间有显著关联。然而,这些观察到的哺乳对未来糖尿病发病的有益影响背后的机制仍然未知。

脂质在T2D的发病机制中起着重要的作用,产后早期的代谢物特征可能有助于有效预测T2D的未来发病。本研究旨在确定最近GDM怀孕的妇女的密集哺乳和代谢特征之间的关联,然后使用选定的代谢物来预测T2D的未来风险。

1、队列设计

SWIFT 是一个由 1035 名女性组成的前瞻性纵向研究组。在1035名没有糖尿病的妇女中,有1010名在基线上被2小时75克的OGTT证实。每年通过2小时75克OGTT对妇女进行跟踪,产后2年(n = 959名妇女),并利用她们的电子病历(EHR)从基线到基线后8年(至2019年1月16日)获得糖尿病的额外临床诊断。基线分析包括总共350名妇女(216 IBF对134 IFF/混合),她们收集了储存的禁食血浆样本,并进行了有针对性的代谢和脂肪学分析。随访和纵向分析包括350名妇女中的303人(188名IBF对115名IFF/混合),她们的禁食血浆样本受到有针对性的代谢分析。

2、参与者临床特征

350名参与者产前和产后的临床、社会人口和生化数据汇总在表中表1。 与IBF妇女相比,IFF/混合妇女孕前体重指数略高(平均±SD:34.1±8.6,而32.2±6.8公斤/米2p = 0.02)。产后6-9周,IBF组的禁食血浆葡萄糖(FPG)(p <0.001)、禁食胰岛素(p <0.001)、HOMA-IR(p <0.001)和HOMA-β(p = 0.006)比IFF/混合组低。与基线的 IFF/混合女性相比,IBF 女性的葡萄糖耐受性受损较少(p = 0.004)。

3、与哺乳强度相关的代谢变化

在IBF和IFF/混合组之间,确定了75种具有统计意义的代谢物(FDR <0.05)。所有FDR < 0.002的差异表达代谢物都汇总并显示在图中(图2B)。值得注意的是,大多数差异表达的代谢物聚集在磷脂类和鞘脂类中,与IFF/混合女性相比,IBF女性中较高(图2B)。

在基线或后续数据中确定的所有显著差异分析显示在图2C,结果表明在同时哺乳期间哺乳强度对代谢物的影响在停止哺乳后显著减轻。此外,我们将这 303 名妇女分为未来没有 T2D(n = 152)、短期 T2D (基线后1-2年发病,n = 102)和长期 T2D(基线后> 2 年发病、n = 49)子组。在未来没有T2D的妇女中,3种代谢物(组氨酸,瓜氨酸和总dma)被发现在IBF和IFF/混合之间有差异,而IBF和IFF/混合在短期和长期T2D子组之间没有发现差异代谢物。

为了进一步确定产后哺乳是否对产妇长期代谢有持续影响,进一步将这303名妇女分层为无T2D(n = 152)、短期T2D(n = 102)和长期T2D(n = 49)子组,并在每个子组中进行纵向分析。 在此期间,没有发现代谢物发生显著变化。

4、与基线哺乳强度相关的脂质种类变化

本研究覆盖了广泛范围的脂质物种(15个类别的1008个脂质物种以及296个脂肪酸),来评估350名妇女(216IBF对134 IFF/混合)基线下与哺乳强度相关的脂质变化。最终的生物信息分析共包括818种脂质。PCA 和 PLS-DA 分析显示,这两组之间有明显的分离。在818种脂质物种中,有581种与基线的哺乳强度显著相关(FDR <0.05),与IFF/混合组相比,IBF中有183种脂质受到调节,398种脂质被降低(图3A)。

值得注意的是,64%(513个测量的TAG中有328个)和83%(54个测量的DAG中有45个)在IBF妇女中显著降低,这表明在基线哺乳强度较高的妇女比密集配方喂养或混合喂养的妇女具有较低的循环TAG和DAG水平,这与临床生化检查是一致的。我们展示了前150个差异表达最显著的脂质种类(图3C),其中81个TAG和23个DAG始终与基线的哺乳强度呈负相关。相比之下,15个鞘磷脂、20个磷脂和11个CE与密集哺乳一直呈正相关(图3C)。

5、与哺乳强度相关的脂质结构和成分的特征

检查脂质的碳原子和双键数量,以深入了解密集哺乳是否影响脂质的组成。本研究中测量的TAG拥有35至60个碳原子,以及0至12个碳原子的双键。IBF女性的TAG明显减少,聚集在碳原子50-56的范围内,尤其是碳原子(50,52,54和60)(图4)。同样,碳原子数量均匀的 DAG(32、34、36、38 和 40)与基线的密集哺乳显著呈负相关。 至于总FAs,大多数长链脂肪酸(FA 16:0,FA 16:1,FA 17:0, FA 18:0、FA 18:1、FA 18:2、FA 20:1和FA 20:2)在IBF中明显下降,而大多数长链脂肪酸(FA 22:0、FA 24:0、FA 24:1、FA 26:0和FA 26:1)则被调高。中链脂肪酸没有观察到任何变化。

6、与哺乳强度相关的代谢通路

结果表明,IBF女性的甘油脂代谢显著下降,涉及TAG/DAG生物合成(p = 0.04)(图5A)。相反,苯丙胺(p = 0.002)和甘油磷脂(p = 0.01)的新陈代谢明显下调。这三种受到显著调节的通路(血糖酸、磷脂和甘油脂代谢)紧密相连,因为它们共享共同的底物,如磷脂酸和脂肪酰基辅酶a,表明从TAG和DAG来源的碳向磷脂和鞘脂转移的路径开关和通量(图5B)。

7、与哺乳相关脂质种类相关的基因和调节元件

本研究结果表明,哺乳强度与脂质代谢的改变有关。我们发现183个上调的脂类(主要是磷脂和鞘磷脂)与296个基因相连,这296个基因与21个主调控子(如PPARA, SREBF1, FOXO1, SOX9, STAT5A)匹配,其中大部分参与脂质代谢(图6)。由主调控子调控的参与哺乳期间脂质代谢的靶向基因簇如图6B所示。相比之下,398种下调的脂类(主要是TAG和DAG)只与一个基因CEPT1相关(图6A)。CEPT1编码胆碱/乙醇胺磷酸转移酶1,,表明甘油脂和磷脂之间有密切的联系。

8、哺乳对未来T2D和非T2D女性基线脂质谱的影响

之前的研究表明,哺乳强度和持续时间与产后2年内T2D发病率的相对风险降低34-57%相关。我们进一步按未来T2D状态对350名近期GDM女性进行分层,并检查密集哺乳是否影响每个亚组的脂质谱。在350名女性中,171名在随访期间(基线后8年)发展了T2D, 179名没有T2D(图7A)。在未来的T2D组中,98名(57.3%)女性被归类为IBF, 73名(42.7%)女性在基线时被归类为IFF/Mixed(图7A)。在无T2D组中,118名(65.9%)女性被归类为IBF,而61名(34.1%)女性在基线时被归类为IFF/Mixed(图7)。在非T2D组中,有552种脂类在IBF和IFF/混合女性(图7B-C)(FDR < 0.05) 。图7D总结并显示FDR < 0.001有差异脂质。在这些脂类中,与IFF/Mixed组相比,IBF组中有185 TAG和35 DAG下调,而19 CEs、55磷脂和33鞘脂上调(图7D)。然而,未来T2D亚组的脂质显著差异表达量远少于没有T2D的女性。在代谢组学分析中也观察到同样的趋势,这表明在代谢上对哺乳没有反应的妇女在GDM妊娠后很可能会发展到未来的T2D。

9、强化母乳喂养妇女未来T2D的预测

为了进一步确定谁更有可能发展未来的T2D,即使是强化母乳喂养,我们建立了一个不同的预测模型,使用10个分析物-1酰基肉碱,2个生物胺,3个氨基酸和4个脂类(图8A)。中位数AUC值为0.78(95% CI 0.65-0.91),远远优于FPG(中位数AUC 0.56, 95% CI 0.39-0.73)和2 h-PG(中位数AUC 0.62,95% CI 0.46-0.78)(图8B-D)。值得注意的是,将临床变量与10分析特征相结合后,预测表现略有改善(中位数AUC 0.80, 95% CI 0.67-0.92),提示代谢特征对预测IBF女性未来T2D的重要性。这些数据表明,在强化母乳喂养的女性T2D真正发病前数年就出现了代谢变化,这使我们能够预测这一特定群体的T2D,并进一步研究与T2D发病机制相关的潜在机制。

综上,哺乳强度与甘油脂(TAGs/DAGs)的减少和基线磷脂/磷脂的增加密切相关。此脂质特征表明,从甘油糖代谢通路转向磷脂/磷脂代谢通路,作为哺乳益处基础机制的组成部分。纵向分析表明,这种有利的脂质变化在产后1-2年是短暂的。重要的是,在后续过程中,当通过未来的 T2D 状态(171 名未来的 T2D 与 179 名没有 T2D)对这 350 名妇女进行分层时,与没有T2D女性相比,后来患T2D的女性与哺乳强度相关的脂质变化较少。随后,我们确定了与未来 T2D 风险密切相关的代谢物集群,从该组代谢物中,我们开发了具有 0.78 的鉴别力 (AUC) 的预测代谢特征,优于常见的临床变量(即禁食葡萄糖、AUC 0.56 或 2 小时葡萄糖、AUC 0.62)。

总的来说,密集哺乳显著改变了产后早期循环的脂质特征,并且对哺乳没有代谢反应的妇女更有可能发展成T2D。我们还发现了一个10分析代谢特征,能够预测IBF女性T2D的未来发病风险。

原文来源:

Zhang et al. Intensive lactation among women withrecent gestational diabetes significantly alters the early postpartum circulating lipid profile: the SWIFT studyBMC Medicine (2021) 19:241.

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createdBy=83be5432074, createdName=ms8000000479463101, createdTime=Thu Oct 14 08:53:05 CST 2021, time=2021-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1060320, encodeId=e7c6106032084, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d05a5574909, createdName=ms7000000909951304, createdTime=Thu Oct 14 07:44:47 CST 2021, time=2021-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1060307, encodeId=a754106030ecb, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210511/e9408422a23545ef9738dd674abfc4ff/c719925083844b82986bc39d43051172.jpg, createdBy=8eb14795142, createdName=与狼共舞, createdTime=Thu Oct 14 06:19:42 CST 2021, time=2021-10-14, status=1, ipAttribution=)]
  3. 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    2021-10-19 ms4000000508774213

    母乳喂养好

    0

  4. 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createdTime=Thu Oct 14 06:19:42 CST 2021, time=2021-10-14, status=1, ipAttribution=)]
    2021-10-15 villahu
  5. 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  6. 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GetPortalCommentsPageByObjectIdResponse(id=1353403, encodeId=26af1353403e5, content=<a href='/topic/show?id=c4d484423fa' target=_blank style='color:#2F92EE;'>#脂质代谢#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84423, encryptionId=c4d484423fa, topicName=脂质代谢)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Fri Oct 15 08:09:25 CST 2021, time=2021-10-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1404392, encodeId=acff140439284, content=<a href='/topic/show?id=db62e905e8' target=_blank style='color:#2F92EE;'>#GDM#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7905, encryptionId=db62e905e8, topicName=GDM)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=330f2470752, createdName=朱睿睿, createdTime=Fri Oct 15 08:09:25 CST 2021, time=2021-10-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1514043, encodeId=db6e15140431e, content=<a href='/topic/show?id=845339961b7' target=_blank style='color:#2F92EE;'>#哺乳#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39961, encryptionId=845339961b7, topicName=哺乳)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c8fd10610597, createdName=ms1065684921169360, createdTime=Fri Oct 15 08:09:25 CST 2021, time=2021-10-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1060333, encodeId=f52d1060333a7, content=学到了,谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=83be5432074, createdName=ms8000000479463101, createdTime=Thu Oct 14 08:53:05 CST 2021, time=2021-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1060320, encodeId=e7c6106032084, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d05a5574909, createdName=ms7000000909951304, createdTime=Thu Oct 14 07:44:47 CST 2021, time=2021-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1060307, encodeId=a754106030ecb, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210511/e9408422a23545ef9738dd674abfc4ff/c719925083844b82986bc39d43051172.jpg, createdBy=8eb14795142, createdName=与狼共舞, createdTime=Thu Oct 14 06:19:42 CST 2021, time=2021-10-14, status=1, ipAttribution=)]
    2021-10-15 朱睿睿
  7. [GetPortalCommentsPageByObjectIdResponse(id=1189571, encodeId=f70711895e107, content=有道理, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee616470317, createdName=ms8000002131411968, createdTime=Tue Feb 01 19:32:36 CST 2022, time=2022-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1665112, encodeId=f8fe1665112f4, content=<a href='/topic/show?id=c8664008e1a' target=_blank style='color:#2F92EE;'>#喂养#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40087, encryptionId=c8664008e1a, topicName=喂养)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0ed425881542, createdName=ms1948154235210413, createdTime=Sat Jan 01 22:09:25 CST 2022, time=2022-01-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1061803, encodeId=46df1061803b7, content=母乳喂养好, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=11245485718, createdName=ms4000000508774213, createdTime=Tue Oct 19 12:51:53 CST 2021, time=2021-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1299642, encodeId=8a7d1299642b3, content=<a href='/topic/show?id=7a056349485' target=_blank style='color:#2F92EE;'>#母乳#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63494, encryptionId=7a056349485, topicName=母乳)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf1b289, createdName=villahu, createdTime=Fri Oct 15 08:09:25 CST 2021, time=2021-10-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1353403, encodeId=26af1353403e5, content=<a href='/topic/show?id=c4d484423fa' target=_blank style='color:#2F92EE;'>#脂质代谢#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84423, encryptionId=c4d484423fa, topicName=脂质代谢)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Fri Oct 15 08:09:25 CST 2021, time=2021-10-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1404392, encodeId=acff140439284, content=<a href='/topic/show?id=db62e905e8' target=_blank style='color:#2F92EE;'>#GDM#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7905, encryptionId=db62e905e8, topicName=GDM)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=330f2470752, createdName=朱睿睿, createdTime=Fri Oct 15 08:09:25 CST 2021, time=2021-10-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1514043, encodeId=db6e15140431e, content=<a href='/topic/show?id=845339961b7' target=_blank style='color:#2F92EE;'>#哺乳#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39961, encryptionId=845339961b7, topicName=哺乳)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c8fd10610597, createdName=ms1065684921169360, createdTime=Fri Oct 15 08:09:25 CST 2021, time=2021-10-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1060333, encodeId=f52d1060333a7, content=学到了,谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=83be5432074, createdName=ms8000000479463101, createdTime=Thu Oct 14 08:53:05 CST 2021, time=2021-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1060320, encodeId=e7c6106032084, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d05a5574909, createdName=ms7000000909951304, createdTime=Thu Oct 14 07:44:47 CST 2021, time=2021-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1060307, encodeId=a754106030ecb, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210511/e9408422a23545ef9738dd674abfc4ff/c719925083844b82986bc39d43051172.jpg, createdBy=8eb14795142, createdName=与狼共舞, createdTime=Thu Oct 14 06:19:42 CST 2021, time=2021-10-14, status=1, ipAttribution=)]
  8. [GetPortalCommentsPageByObjectIdResponse(id=1189571, encodeId=f70711895e107, content=有道理, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee616470317, createdName=ms8000002131411968, createdTime=Tue Feb 01 19:32:36 CST 2022, time=2022-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1665112, encodeId=f8fe1665112f4, content=<a href='/topic/show?id=c8664008e1a' target=_blank style='color:#2F92EE;'>#喂养#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40087, encryptionId=c8664008e1a, topicName=喂养)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0ed425881542, createdName=ms1948154235210413, createdTime=Sat Jan 01 22:09:25 CST 2022, time=2022-01-01, status=1, ipAttribution=), 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createdName=朱睿睿, createdTime=Fri Oct 15 08:09:25 CST 2021, time=2021-10-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1514043, encodeId=db6e15140431e, content=<a href='/topic/show?id=845339961b7' target=_blank style='color:#2F92EE;'>#哺乳#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39961, encryptionId=845339961b7, topicName=哺乳)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c8fd10610597, createdName=ms1065684921169360, createdTime=Fri Oct 15 08:09:25 CST 2021, time=2021-10-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1060333, encodeId=f52d1060333a7, content=学到了,谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=83be5432074, createdName=ms8000000479463101, createdTime=Thu Oct 14 08:53:05 CST 2021, time=2021-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1060320, encodeId=e7c6106032084, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d05a5574909, createdName=ms7000000909951304, createdTime=Thu Oct 14 07:44:47 CST 2021, time=2021-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1060307, encodeId=a754106030ecb, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210511/e9408422a23545ef9738dd674abfc4ff/c719925083844b82986bc39d43051172.jpg, createdBy=8eb14795142, createdName=与狼共舞, createdTime=Thu Oct 14 06:19:42 CST 2021, time=2021-10-14, status=1, ipAttribution=)]
    2021-10-14 ms8000000479463101

    学到了,谢谢

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=1189571, encodeId=f70711895e107, content=有道理, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee616470317, createdName=ms8000002131411968, createdTime=Tue Feb 01 19:32:36 CST 2022, time=2022-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1665112, encodeId=f8fe1665112f4, content=<a href='/topic/show?id=c8664008e1a' target=_blank style='color:#2F92EE;'>#喂养#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40087, encryptionId=c8664008e1a, topicName=喂养)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0ed425881542, createdName=ms1948154235210413, createdTime=Sat Jan 01 22:09:25 CST 2022, time=2022-01-01, status=1, ipAttribution=), 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createdName=朱睿睿, createdTime=Fri Oct 15 08:09:25 CST 2021, time=2021-10-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1514043, encodeId=db6e15140431e, content=<a href='/topic/show?id=845339961b7' target=_blank style='color:#2F92EE;'>#哺乳#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39961, encryptionId=845339961b7, topicName=哺乳)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c8fd10610597, createdName=ms1065684921169360, createdTime=Fri Oct 15 08:09:25 CST 2021, time=2021-10-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1060333, encodeId=f52d1060333a7, content=学到了,谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=83be5432074, createdName=ms8000000479463101, createdTime=Thu Oct 14 08:53:05 CST 2021, time=2021-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1060320, encodeId=e7c6106032084, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d05a5574909, createdName=ms7000000909951304, createdTime=Thu Oct 14 07:44:47 CST 2021, time=2021-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1060307, encodeId=a754106030ecb, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210511/e9408422a23545ef9738dd674abfc4ff/c719925083844b82986bc39d43051172.jpg, createdBy=8eb14795142, createdName=与狼共舞, createdTime=Thu Oct 14 06:19:42 CST 2021, time=2021-10-14, status=1, ipAttribution=)]
    2021-10-14 ms7000000909951304

    学习了

    0

  10. 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GetPortalCommentsPageByObjectIdResponse(id=1061803, encodeId=46df1061803b7, content=母乳喂养好, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=11245485718, createdName=ms4000000508774213, createdTime=Tue Oct 19 12:51:53 CST 2021, time=2021-10-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1299642, encodeId=8a7d1299642b3, content=<a href='/topic/show?id=7a056349485' target=_blank style='color:#2F92EE;'>#母乳#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63494, encryptionId=7a056349485, topicName=母乳)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf1b289, createdName=villahu, createdTime=Fri Oct 15 08:09:25 CST 2021, time=2021-10-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1353403, encodeId=26af1353403e5, content=<a href='/topic/show?id=c4d484423fa' target=_blank style='color:#2F92EE;'>#脂质代谢#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84423, encryptionId=c4d484423fa, topicName=脂质代谢)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Fri Oct 15 08:09:25 CST 2021, time=2021-10-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1404392, encodeId=acff140439284, content=<a href='/topic/show?id=db62e905e8' target=_blank style='color:#2F92EE;'>#GDM#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7905, encryptionId=db62e905e8, topicName=GDM)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=330f2470752, createdName=朱睿睿, createdTime=Fri Oct 15 08:09:25 CST 2021, time=2021-10-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1514043, encodeId=db6e15140431e, content=<a href='/topic/show?id=845339961b7' target=_blank style='color:#2F92EE;'>#哺乳#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39961, encryptionId=845339961b7, topicName=哺乳)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c8fd10610597, createdName=ms1065684921169360, createdTime=Fri Oct 15 08:09:25 CST 2021, time=2021-10-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1060333, encodeId=f52d1060333a7, content=学到了,谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=83be5432074, createdName=ms8000000479463101, createdTime=Thu Oct 14 08:53:05 CST 2021, time=2021-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1060320, encodeId=e7c6106032084, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d05a5574909, createdName=ms7000000909951304, createdTime=Thu Oct 14 07:44:47 CST 2021, time=2021-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1060307, encodeId=a754106030ecb, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210511/e9408422a23545ef9738dd674abfc4ff/c719925083844b82986bc39d43051172.jpg, createdBy=8eb14795142, createdName=与狼共舞, createdTime=Thu Oct 14 06:19:42 CST 2021, time=2021-10-14, status=1, ipAttribution=)]
    2021-10-14 与狼共舞

    学习学习

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