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JAMA:静脉输注免疫球蛋白+甲基泼尼松龙 vs. 单纯输注免疫球蛋白对儿童多系统炎症综合征发热病程的影响

2021-02-02 MedSci原创 MedSci原创

导语:新冠病毒对儿童患者的影响

导语:新冠病毒对儿童患者的影响

 

在2019年冠状病毒病(COVID-19)住院患者中,仅有1%至2%的患者为儿童。 然而,2020年4月,欧洲和美国出现了严重的全身高炎性疾病的儿童患者,这些患者多在新型冠状病毒(SARS-CoV-2)感染后的2至4周内。 这种新颖的疾病被称为儿童多系统炎性综合征(MIS-C)或与COVID-19暂时相关的儿童多系统炎性综合征。表现出多种临床症状,包括持续发热,消化系统症状,皮疹,双侧非化脓性结膜炎,皮肤粘膜炎症迹象和频繁的血管受累。MIS-C通常与血液动力学衰竭有关,在60%至75%的病例中出现了急性心脏功能障碍,甚至死亡。


许多患有MIS-C的儿童接受了根据川崎病指南的经验性治疗,单独使用静脉免疫球蛋白(IVIG)或与皮质类固醇结合使用。 而在某些研究中,儿童则需要二线治疗,例如肿瘤坏死因子抑制剂或白介素1(IL-1)抑制剂,这凸显了定义最佳初始治疗的重要性。
然而到目前为止,仍然缺少最有效的MIS-C疗法的证据。 在缺乏证据的情况下,英国Delphi共识研究建议以IVIG作为初始治疗方法来治疗MIS-C。

这项回顾性队列研究的目的是比较用IVIG和甲基强的松龙与单独使用IVIG治疗的MIS-C合并SARS-CoV-2感染的儿童的结局。

主要结局为治疗失败,定义为从开始给药起,接受初始治疗后持续2天(48小时)发烧,或在初始治疗后7天内再次发烧。该结果与川崎病的治疗研究中使用的主要结果相似。发烧定义为38°C(即≥100.4°F)或更高的温度。


次要结果是二线治疗,定义为在初次治疗至少24小时后对MIS-C进行二次治疗,如类固醇或生物制剂。 一线治疗后的对血流动力学的支持; 一线治疗后如左心室射血分数小于55%,则定义为急性左心室功能障碍; 以及在小儿重症监护室(PICU)的住院时间。对于血液动力学支持和急性左心功能不全,仅考虑在一线治疗开始后至少1天发生。对血流动力学支持被定义为使用血管活性或正性胺,而不是先前处方药物的升级。


在181名怀疑有MIS-C的儿童中,有111名符合世界卫生组织的定义(58名女性[52%];中位年龄为8.6岁[四分位间距为4.7至12.1])。五个孩子未接受任何治疗。 总体而言,IVIG和甲基强的松龙组(以下简称联合组)的34名儿童中有3名(9%)对治疗无反应,仅IVIG组的72名儿童中这一数据为37名(51%)。联合组与仅IVIG组的治疗相比,具有较低的治疗失败风险(绝对风险差异,-0.28 [95%CI,-0.48至-0.08];优势比[OR],0.25,[95%CI,0.09至0.70 ]; P = .008)。联合组与仅IVIG组相比,使用二线治疗的风险也显著降低(绝对风险差异为-0.22 [95%CI,-0.40至-0.04];优势比0.19 [95%CI,0.06至 0.61]; P = .004),血液动力学支持(绝对风险差异,-0.17 [95%CI,-0.34至-0.004]; 优势比0.21 [95%CI,0.06至0.76]),急性左心功能不全初始治疗(绝对风险差异,-0.18 [95%CI,-0.35至-0.01]; 优势比0.20 [95%CI,0.06至0.66]),以及在小儿重症监护室的住院时间(中位数,4天vs6天;天差为-2.4 [95%CI,-4.0至-0.7])。


实验结果表明,在MIS-C患儿中,比起单独使用IVIG,联合IVIG和甲基泼尼松龙的治疗具有更顺利的发热病程。

原文链接:https://jamanetwork.com/journals/jama/fullarticle/2776054

Naïm Ouldali, MD, PhD1,2,3; Julie Toubiana, MD, PhD. Published online February 1, 2021. doi:10.1001/jama.2021.0694

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    2021-08-28 xzw113
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    2021-10-12 xugc
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href='/topic/show?id=adbe650e465' target=_blank style='color:#2F92EE;'>#泼尼松龙#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65074, encryptionId=adbe650e465, topicName=泼尼松龙)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fb4914457810, createdName=xjy07, createdTime=Thu Feb 04 00:45:03 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036430, encodeId=f9eb103643021, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Tue Feb 02 12:45:03 CST 2021, time=2021-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922154, encodeId=cfb492215428, content=丙球和激素对免疫性疾病的治疗还是有用的, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Tue Feb 02 11:07:45 CST 2021, time=2021-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922137, encodeId=205692213ea2, content=😁, beContent=null, objectType=article, channel=null, level=null, likeNumber=133, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9f1d2583439, createdName=125aa67fm53暂无昵称, createdTime=Tue Feb 02 10:02:22 CST 2021, time=2021-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922134, encodeId=5011922134bc, content=认真学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Tue Feb 02 09:57:55 CST 2021, time=2021-02-02, status=1, ipAttribution=)]
    2021-12-23 fusion
  4. 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href='/topic/show?id=adbe650e465' target=_blank style='color:#2F92EE;'>#泼尼松龙#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65074, encryptionId=adbe650e465, topicName=泼尼松龙)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fb4914457810, createdName=xjy07, createdTime=Thu Feb 04 00:45:03 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036430, encodeId=f9eb103643021, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Tue Feb 02 12:45:03 CST 2021, time=2021-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922154, encodeId=cfb492215428, 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beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Tue Feb 02 09:57:55 CST 2021, time=2021-02-02, status=1, ipAttribution=)]
  5. 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href='/topic/show?id=adbe650e465' target=_blank style='color:#2F92EE;'>#泼尼松龙#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65074, encryptionId=adbe650e465, topicName=泼尼松龙)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fb4914457810, createdName=xjy07, createdTime=Thu Feb 04 00:45:03 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036430, encodeId=f9eb103643021, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Tue Feb 02 12:45:03 CST 2021, time=2021-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922154, encodeId=cfb492215428, 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  6. 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href='/topic/show?id=adbe650e465' target=_blank style='color:#2F92EE;'>#泼尼松龙#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65074, encryptionId=adbe650e465, topicName=泼尼松龙)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fb4914457810, createdName=xjy07, createdTime=Thu Feb 04 00:45:03 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036430, encodeId=f9eb103643021, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Tue Feb 02 12:45:03 CST 2021, time=2021-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922154, encodeId=cfb492215428, content=丙球和激素对免疫性疾病的治疗还是有用的, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Tue Feb 02 11:07:45 CST 2021, time=2021-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922137, encodeId=205692213ea2, content=😁, beContent=null, objectType=article, channel=null, level=null, likeNumber=133, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9f1d2583439, createdName=125aa67fm53暂无昵称, createdTime=Tue Feb 02 10:02:22 CST 2021, time=2021-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922134, encodeId=5011922134bc, content=认真学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Tue Feb 02 09:57:55 CST 2021, time=2021-02-02, status=1, ipAttribution=)]
  7. [GetPortalCommentsPageByObjectIdResponse(id=2035242, encodeId=3cfd20352420b, content=<a href='/topic/show?id=5a426866eae' target=_blank style='color:#2F92EE;'>#球蛋白#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68667, encryptionId=5a426866eae, topicName=球蛋白)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2317301, createdName=xzw113, createdTime=Sat Aug 28 08:45:03 CST 2021, time=2021-08-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1972134, encodeId=eeac19e2134f0, content=<a href='/topic/show?id=d6449919ed1' target=_blank style='color:#2F92EE;'>#静脉输注#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99197, encryptionId=d6449919ed1, topicName=静脉输注)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e1c493, createdName=xugc, createdTime=Tue Oct 12 20:45:03 CST 2021, time=2021-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1698192, encodeId=0a9316981925d, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Thu Dec 23 07:45:03 CST 2021, time=2021-12-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1283920, encodeId=b471128392026, content=<a href='/topic/show?id=ce1b2908938' target=_blank style='color:#2F92EE;'>#免疫球蛋白#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=29089, encryptionId=ce1b2908938, topicName=免疫球蛋白)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=560d188, createdName=nymo, createdTime=Thu Feb 04 00:45:03 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1432001, encodeId=f811143200176, content=<a href='/topic/show?id=f9b9e9124a8' target=_blank style='color:#2F92EE;'>#综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79124, encryptionId=f9b9e9124a8, topicName=综合征)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Thu Feb 04 00:45:03 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1553899, encodeId=f9ec155389932, content=<a href='/topic/show?id=adbe650e465' target=_blank style='color:#2F92EE;'>#泼尼松龙#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65074, encryptionId=adbe650e465, topicName=泼尼松龙)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fb4914457810, createdName=xjy07, createdTime=Thu Feb 04 00:45:03 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036430, encodeId=f9eb103643021, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Tue Feb 02 12:45:03 CST 2021, time=2021-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922154, encodeId=cfb492215428, content=丙球和激素对免疫性疾病的治疗还是有用的, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Tue Feb 02 11:07:45 CST 2021, time=2021-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922137, encodeId=205692213ea2, content=😁, beContent=null, objectType=article, channel=null, level=null, likeNumber=133, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9f1d2583439, createdName=125aa67fm53暂无昵称, createdTime=Tue Feb 02 10:02:22 CST 2021, time=2021-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922134, encodeId=5011922134bc, content=认真学习了。, 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    2021-02-02 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=2035242, encodeId=3cfd20352420b, content=<a href='/topic/show?id=5a426866eae' target=_blank style='color:#2F92EE;'>#球蛋白#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68667, encryptionId=5a426866eae, topicName=球蛋白)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2317301, createdName=xzw113, createdTime=Sat Aug 28 08:45:03 CST 2021, time=2021-08-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1972134, encodeId=eeac19e2134f0, content=<a href='/topic/show?id=d6449919ed1' target=_blank style='color:#2F92EE;'>#静脉输注#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99197, encryptionId=d6449919ed1, topicName=静脉输注)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e1c493, 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encryptionId=ce1b2908938, topicName=免疫球蛋白)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=560d188, createdName=nymo, createdTime=Thu Feb 04 00:45:03 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1432001, encodeId=f811143200176, content=<a href='/topic/show?id=f9b9e9124a8' target=_blank style='color:#2F92EE;'>#综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79124, encryptionId=f9b9e9124a8, topicName=综合征)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Thu Feb 04 00:45:03 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1553899, encodeId=f9ec155389932, content=<a href='/topic/show?id=adbe650e465' target=_blank style='color:#2F92EE;'>#泼尼松龙#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65074, encryptionId=adbe650e465, topicName=泼尼松龙)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fb4914457810, createdName=xjy07, createdTime=Thu Feb 04 00:45:03 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036430, encodeId=f9eb103643021, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Tue Feb 02 12:45:03 CST 2021, time=2021-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922154, encodeId=cfb492215428, content=丙球和激素对免疫性疾病的治疗还是有用的, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Tue Feb 02 11:07:45 CST 2021, time=2021-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922137, encodeId=205692213ea2, content=😁, beContent=null, objectType=article, channel=null, level=null, likeNumber=133, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9f1d2583439, createdName=125aa67fm53暂无昵称, createdTime=Tue Feb 02 10:02:22 CST 2021, time=2021-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922134, encodeId=5011922134bc, content=认真学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Tue Feb 02 09:57:55 CST 2021, time=2021-02-02, status=1, ipAttribution=)]
    2021-02-02 易水河

    丙球和激素对免疫性疾病的治疗还是有用的

    0

  9. 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encryptionId=ce1b2908938, topicName=免疫球蛋白)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=560d188, createdName=nymo, createdTime=Thu Feb 04 00:45:03 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1432001, encodeId=f811143200176, content=<a href='/topic/show?id=f9b9e9124a8' target=_blank style='color:#2F92EE;'>#综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79124, encryptionId=f9b9e9124a8, topicName=综合征)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Thu Feb 04 00:45:03 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1553899, encodeId=f9ec155389932, content=<a href='/topic/show?id=adbe650e465' target=_blank style='color:#2F92EE;'>#泼尼松龙#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65074, encryptionId=adbe650e465, topicName=泼尼松龙)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fb4914457810, createdName=xjy07, createdTime=Thu Feb 04 00:45:03 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036430, encodeId=f9eb103643021, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Tue Feb 02 12:45:03 CST 2021, time=2021-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922154, encodeId=cfb492215428, content=丙球和激素对免疫性疾病的治疗还是有用的, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Tue Feb 02 11:07:45 CST 2021, time=2021-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922137, encodeId=205692213ea2, content=😁, beContent=null, objectType=article, channel=null, level=null, likeNumber=133, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9f1d2583439, createdName=125aa67fm53暂无昵称, createdTime=Tue Feb 02 10:02:22 CST 2021, time=2021-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922134, encodeId=5011922134bc, content=认真学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Tue Feb 02 09:57:55 CST 2021, time=2021-02-02, status=1, ipAttribution=)]
    2021-02-02 125aa67fm53暂无昵称

    😁

    0

  10. 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createdName=xugc, createdTime=Tue Oct 12 20:45:03 CST 2021, time=2021-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1698192, encodeId=0a9316981925d, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Thu Dec 23 07:45:03 CST 2021, time=2021-12-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1283920, encodeId=b471128392026, content=<a href='/topic/show?id=ce1b2908938' target=_blank style='color:#2F92EE;'>#免疫球蛋白#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=29089, encryptionId=ce1b2908938, topicName=免疫球蛋白)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=560d188, createdName=nymo, createdTime=Thu Feb 04 00:45:03 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1432001, encodeId=f811143200176, content=<a href='/topic/show?id=f9b9e9124a8' target=_blank style='color:#2F92EE;'>#综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79124, encryptionId=f9b9e9124a8, topicName=综合征)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Thu Feb 04 00:45:03 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1553899, encodeId=f9ec155389932, content=<a href='/topic/show?id=adbe650e465' target=_blank style='color:#2F92EE;'>#泼尼松龙#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65074, encryptionId=adbe650e465, topicName=泼尼松龙)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fb4914457810, createdName=xjy07, createdTime=Thu Feb 04 00:45:03 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036430, encodeId=f9eb103643021, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Tue Feb 02 12:45:03 CST 2021, time=2021-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922154, encodeId=cfb492215428, content=丙球和激素对免疫性疾病的治疗还是有用的, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Tue Feb 02 11:07:45 CST 2021, time=2021-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922137, encodeId=205692213ea2, content=😁, beContent=null, objectType=article, channel=null, level=null, likeNumber=133, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9f1d2583439, createdName=125aa67fm53暂无昵称, createdTime=Tue Feb 02 10:02:22 CST 2021, time=2021-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922134, encodeId=5011922134bc, content=认真学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Tue Feb 02 09:57:55 CST 2021, time=2021-02-02, status=1, ipAttribution=)]
    2021-02-02 医鸣惊人

    认真学习了。

    0

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