Baidu
map

Graves病伴甲亢性心脏病 如何在用抗甲状腺药物治疗时减小副作用?

2017-07-14 王绵 张力辉 殷立新 内分泌系统疾病

此病例中,患者出现消瘦伴4个月胸闷气短,入院诊断为Graves病、甲亢性心脏病、布氏杆菌病。医生在治疗中应采取哪些措施缓解抗甲状腺药物的副作用?对白细胞减少和肝功能异常者应如何权衡利弊,选择合理的治疗方案?通过本病例,医生可以更全面地了解甲亢、甲亢性心脏病的诊断和治疗要点以及注意事项。【学习目的】1﹒了解甲亢的常见病因及GD的发病机制。2﹒熟悉甲亢的临床表现、实验室检查结果判断、甲亢性心脏病的

此病例中,患者出现消瘦伴4个月胸闷气短,入院诊断为Graves病、甲亢性心脏病、布氏杆菌病。医生在治疗中应采取哪些措施缓解抗甲状腺药物的副作用?对白细胞减少和肝功能异常者应如何权衡利弊,选择合理的治疗方案?通过本病例,医生可以更全面地了解甲亢、甲亢性心脏病的诊断和治疗要点以及注意事项。

【学习目的】

1﹒了解甲亢的常见病因及GD的发病机制。

2﹒熟悉甲亢的临床表现、实验室检查结果判断、甲亢性心脏病的诊断标准。

3﹒掌握不同抗甲状腺药物的适应证、常见不良反应等。

病例介绍

主诉 消瘦伴胸闷气短4个月。

现病史 4个月前患者出现消瘦、胸闷、气短,有时咳嗽,咳少量白色黏痰,未曾诊治。1个月前患者胸闷气短加重,伴双下肢水肿,于当地医院两次住院治疗。查WBC2.45 ×109/L,血钠:132.1mmol/L,甲状腺功能:FT434﹒29p mol/L,TSH 0﹒01μI U/ml,布氏杆菌凝集试验1 ∶100(阳性)。诊断为甲亢、甲亢性心脏病、心力衰竭;电解质紊乱;布氏杆菌病。给予甲巯咪唑口服,1次10mg,1日3次,同时给予强心、利尿、扩血管、纠正电解质紊乱、升高白细胞等综合治疗,患者仍发热、胸闷、气短。为求进一步诊治收入院。

患者自发病以来,食欲缺乏,怕热,腹胀,大便每日1~2次,黄色软便,小便正常,体重下降约8kg,无咳血、胸痛,无端坐呼吸及夜间阵发性呼气困难,无腹痛、腹泻。

既往史 30年前左下肢骨折病史,石膏固定后治愈。1年前诊断布氏杆菌病,在当地接受四环素治疗。无肝炎、结核等传染病史。预防接种史不详。

家族史 无家族性遗传病及传染病史。

个人史 生于原籍,久居当地。从事多年畜牧业。无烟、酒等不良嗜好,无性病史。抱养1女,爱人20年前因糖尿病并发症病逝。

既往用药史 见现病史。

过敏史 对安乃近过敏。

【体格检查】

一般状况 男性,57岁,身高153c m,体重43kg,发育正常,营养一般。神清语利,查体合作。

生命体征 T 38﹒0℃,P 110次/分,R20次/分,BP 110/70mmHg。

皮肤 全身皮肤黏膜无黄染,无皮下出血、皮疹,无肝掌及蜘蛛痣。全身浅表淋巴结未及肿大。

五官 头颅无畸形,球结膜无水肿,巩膜无黄染,双侧瞳孔正大等圆,直径约3mm,对光反射存在,耳鼻检查无异常。口唇无发绀,咽无充血,扁桃体无肿大。

颈部 颈软,气管居中,甲状腺不大,未闻及血管杂音,无颈静脉怒张,未触及肿大淋巴结。

胸部 胸廓对称,无皮下气肿,胸骨无压痛,双侧呼吸动度对称,语颤正常,叩诊清音,双肺呼吸音清晰,未闻及干湿啰音。

心脏 心前区无隆起,心率110次/分,心律齐,心音稍低,各瓣膜区未闻及杂音。

腹部 腹平坦,未见胃肠型及蠕动波,无腹壁静脉曲张。全腹无压痛,肝于剑下2c m,质中等,边钝,无触痛。叩诊鼓音,移动性浊音阴性。肠鸣音正常。

四肢 脊柱、四肢无畸形,肌张力正常。双下肢轻度指凹性水肿。

神经系统 生理反射存在,双巴氏征阴性。脑膜刺激征阴性。

辅助检查

1﹒血常规 WBC 5﹒6 ×109/L,PLT 212 ×109/L,HGB 160g/L。

2﹒甲状腺功能 FT312﹒04p mol/L,FT457﹒74p mol/L,TSH <0.01μI U/ml,TPOAb >1 300U/ml,TRAb阳性。

3﹒生化 TBIL 53μmol/L,DBIL 23﹒7μmol/L,IBIL 29﹒3μmol/L,ALP 147 U/L,GGT 97U/L,TP 89g/L,Na 125﹒9mmol/L,Cl 87﹒4mmol/L。

4﹒布氏杆菌凝集试验阳性。

5﹒心电图 Ⅱ、Ⅲ、avF、V4~V6导联ST段压低,Ⅱ、V2~V6导联T波倒置。

6﹒心脏彩超 左房扩大,二尖瓣轻度关闭不全,主动脉瓣钙化,轻度关闭不全,三尖瓣中度关闭不全,肺动脉高压,中等量心包积液。

入院诊断

1﹒Graves病,甲亢 甲亢性心脏病、心力衰竭、心包积液。

2﹒布氏杆菌病。

3﹒电解质紊乱低钠低氯血症。

诊疗经过 患者诊断明确,入院后给予内科Ⅱ级护理,初始医嘱如下:

高热量、高维生素、低碘饮食

酒石酸美托洛尔片25mg bid po

利可君片20mg tid po

维生素B1片20mg tid po

注射用肌氨肽苷20mg +注射用复合辅酶0.2mg +0.9%氯化钠注射液250ml ivgtt qd

注射用阿奇霉素0.5g+5%葡萄糖注射液500ml ivgtt qd(院外应用)

盐酸左氧氟沙星注射液0.2g +0.9%氯化钠注射液250ml ivgtt qd(院外应用)

甲亢性心脏病是甲亢的特殊临床表现之一,如果在甲亢诊断明确以后,具有下述心脏异常至少一项,可诊断为甲亢性心脏病:①心脏增大;②严重心率失常,如阵发性或持续性的心房纤颤、房扑、频发房性早搏或频发室性早搏、传导阻滞等;③充血性心力衰竭;④心绞痛或心肌梗死。诊断过程中还应该注意除外同时存在的其他原因引起的心脏病变。

入院后根据患者:①从事畜牧工作多年,1年多前无明显诱因出现发热,体温38.5℃左右,于当地防疫站诊断为布氏杆菌病给予四环素等治疗后好转;②消瘦伴胸闷气短4个月;③甲状腺功能示:FT312﹒04p mol/L,FT457﹒74p mol/L,TSH <0.01μI U/ml,TPOAb >1 300U/ml;④心脏彩超:左房扩大,二尖瓣轻度关闭不全,主动脉瓣钙化,轻度关闭不全,三尖瓣中度关闭不全,肺动脉高压,中等量心包积液;⑤生化:TBIL 53μmol/L,DBI 23﹒7μmol/L,IBIL 29﹒3μmol/L,ALP 147U/L,GGT 97U/L,TP 89g/L,Na 125﹒9mmol/L,Cl 87﹒4mmol/L;⑥布氏杆菌凝集试验阳性。支持诊断:①Graves病、甲亢、甲亢性心脏病、心力衰竭、心包积液;②布氏杆菌病;③电解质紊乱、低钠低氯血症。鉴于患者已应用甲巯咪唑1个月,并且于当地医院查肝功能异常,心力衰竭纠正后,肝功能异常不仅没有改善,还有所发展,故排除因心力衰竭所致的肝功能异常,给予复方甘草酸单铵注射液保肝治疗。患者于当地医院查白细胞低,应用利可君后有所上升,故将利可君调整为1次40 mg,1日3次,进一步升高白细胞治疗。患者冷凝集试验阳性,诊断布氏杆菌病,布氏杆菌病对四环素及磺胺类药物敏感,停阿奇霉素,给予四环素口服,1次0.5g,1日3次。同时给予强心利尿治疗以纠正心力衰竭:地高辛1次0.25 mg,1日1次;呋塞米1次20mg,1日2次;螺内酯1次20mg,1日1次;同时记24小时出入量。应用泮托拉唑抑酸治疗,高渗盐纠正低钠血症。同时补充热量。住院期间甲状腺彩超示:甲状腺弥漫性病变伴左叶高回声病变。综合治疗后患者不适症状明显缓解,1周后复查,电解质:Na 128﹒1mmol/L,Cl 97mmol/L。血常规:WBC2.31 ×109/L,PLT 85 ×109/L。因为白细胞经上述治疗后仍明显低于正常,所以应用重组人粒细胞刺激因子皮下注射以升高白细胞治疗。针对心包积液请心内科会诊,示:中等量心包积液可不必行心包穿刺,射血分数不低,BNP 342pg/ml,可停用地高辛,给予盐酸多巴胺注射液20mg以2μg/(kg ?min)泵点,以利尿减轻心脏负荷。重组人粒细胞刺激因子应用3天后复查血常规:WBC 23﹒2 ×109/L,NE%90﹒1%,PLT 74 ×109/L,停用重组人粒细胞刺激因子。住院两周时复查电解质:Na 132﹒2mmol/L,Cl 101﹒9mmol/L,停用静脉补充高渗盐,住院期间查血皮质醇不低(599nmmol/L),不考虑肾上腺皮质功能减退所致低钠血症,患者的低钠血症考虑是由于院外较长时间应用大量利尿剂、尿钠排出增多,同时患者食欲不好、摄入减少引起。共住院3周,患者精神、饮食、睡眠尚可,无发热、咳嗽,无胸闷、气短,双下肢无水肿,停用利尿剂,再次复查血常规:WBC 4﹒19 ×109/L,NEUT%44﹒1%,PLT 90 ×109/L,考虑患者感染已控制,白细胞恢复正常并且稳定,结合患者应用抗甲状腺药物后出现的肝功损伤及白细胞减少,不适合长期应用抗甲状腺药物,故建议予以放射性核素131I治疗。准予出院,嘱其规律用药,定期复查。

出院诊断

1﹒Graves病,甲亢 甲亢性心脏病,心力衰竭,心包积液。

2﹒布氏杆菌病。

3﹒电解质紊乱 低钠低氯血症。

病例特点与诊断要点

1﹒病史 从事畜牧工作多年,1年多前无明显诱因出现发热,体温38.5℃左右,当地诊断布氏杆菌病。

2﹒患者有大便次数增多、体重下降、怕热、多汗等高代谢症状,同时随病程延长,近4个月出现了胸闷、气短,无夜间不能平卧。查体双眼球不突,甲状腺不大,未闻及血管杂音,无颈静脉怒张,心率快,110次/分,心界大,肝脏稍大,肝颈静脉逆流征阴性,双下肢无水肿(已在院外应用了强心药和利尿药)。

3﹒甲状腺功能示FT312﹒04p mol/L,FT457﹒74p mol/L,TSH <0.01μI U/ml,TPOAb>1 300U/ml,TRAb阳性。

4﹒心脏彩超 左房扩大,二尖瓣轻度关闭不全,主动脉瓣钙化,轻度关闭不全,三尖瓣中度关闭不全,肺动脉高压,中等量心包积液。射血分数不低。

5﹒甲状腺超声 甲状腺弥漫性病变伴左叶高回声病变。

6﹒生化 TBIL 53μmol/L,DBIL 23﹒7μmol/L,IBIL 29﹒3μmol/L,ALP 147U/L,GGT 97U/L,TP 89g/L,Na 125﹒9mmol/L,Cl 87﹒4mmol/L。

7﹒血常规 应用抗甲状腺药物后白细胞最低时2.31 ×109/L,中性粒细胞1.2×109/L。

8﹒冷凝集试验阳性。

用药分析与药学监护

甲亢的一般治疗包括注意休息、补充足够热量和营养如糖、蛋白质和B族维生素。失眠可给苯二氮类镇静药如地西泮。心悸明显者可给β受体阻断剂,如普萘洛尔1次10~20mg,1日3次,或美托洛尔1次25~50mg,1日2次。目前,针对甲亢的治疗主要采用以下3种方式:①抗甲状腺药物;②131I治疗;③甲状腺次全切除手术。3种疗法各有利弊。抗甲状腺药物治疗可以保留甲状腺产生激素的功能,但是疗程长、治愈率低,复发率高;131I和甲状腺次全切除都是通过破坏甲状腺组织来减少甲状腺激素的合成和分泌,疗程短、治愈率高、复发率低;但是甲减的发生率显著增高。

1﹒抗甲状腺药物(antithyroid drugs,ATD)

主要药物有甲巯咪唑(MMI)、丙硫氧嘧啶(PT U)。ATD治疗Graves病的缓解率为30%~70%不等,平均50%。适用于病情轻、甲状腺轻、中度肿大的甲亢患者。年龄在20岁以下、妊娠甲亢、年老体弱或合并严重心、肝、肾疾病不能耐受手术者均宜采用药物治疗。一般情况下治疗方法为:MMI 1日30~45mg,分3次口服;或PT U 1日300~450mg,分3次口服。MMI半衰期长,可以每日单次服用。当症状消失,血中甲状腺激素水平接近正常后逐渐减量。由于T4的血浆半衰期为7天,加之甲状腺内储存的甲状腺激素释放约需要两周时间,所以ATD开始发挥作用多在4周以后。减量时每2~4周减药1次,每次M MI减量5~10mg(PT U 50~100 mg),减至最低有效剂量时维持治疗。维持剂量M MI 1日5~10mg,PT U 1日50~100mg,总疗程一般为1~1.5年。起始剂量、减量速度、维持剂量和总疗程均有个体差异,需要根据临床实际掌握。治疗中应当监测甲状腺激素的水平;但是不能用TSH作为治疗目标,因为TSH的变化滞后于甲状腺激素水平4~6周。

抗甲状腺药物的常见副作用是皮疹、皮肤瘙痒、白细胞减少症、粒细胞减少症、中毒性肝病和血管炎等。M MI的副作用是剂量依赖性的,PT U的副作用则是非剂量依赖性的。两药交叉反应发生率为50%。发生白细胞减少(<4.0×109/L),但中性粒细胞>1.5×1009/L,通常不需要停药,减少抗甲状腺药物剂量,加用一般升白细胞药物,如维生素B、鲨肝醇等。注意甲亢在病情还未被控制时也可以引起白细胞减少,所以应当在用药前常规检查白细胞数目作为对照。皮疹和瘙痒的发生率为10%,用抗组织胺药物多可纠正;如皮疹严重应停药,以免发生剥脱性皮炎。出现关节疼痛者应当停药,否则会发展为ATD关节炎综合征,即严重的一过性游走性多关节炎。

粒细胞缺乏症(外周血中性粒细胞绝对计数<0.5×09/L)是ATD的严重并发症。老年患者发生本症的危险性增加。多数病例发生在ATD最初治疗的2~3个月或再次用药的1~2个月内,但也可发生在服药的任何时间。患者的主要临床表现是发热、咽痛、全身不适等,严重者出现败血症,病死率较高。故治疗中出现发热、咽痛均要立即检查白细胞,以及时发现粒细胞缺乏的发生。建议在治疗中定期检查白细胞,若中性粒细胞<1.5×109/L应当立即停药。粒细胞集落刺激因子(G‐CSF)可以促进骨髓恢复,但是对骨髓造血功能损伤严重的病例效果不佳。在一些情况下,糖皮质激素在粒细胞缺乏症时也可以使用。PT U和MMI均可以引起粒细胞缺乏症,两者有交叉反应。所以其中一种药物引起本症,不要换用另外一种药物继续治疗。

中毒性肝病的发生率为0.1%~0.2%。多在用药后3周发生。表现为变态反应性肝炎。转氨酶显著上升,肝脏穿刺可见片状肝细胞坏死,病死率高达25%~30%。PT U可以引起20%~30%的患者转氨酶升高,升高幅度为正常值的1.1~1.6倍。PT U引起的中毒性肝病与其引起的转氨酶升高很难鉴别。另外,甲亢本身也有转氨酶增高,在用药前应检查基础肝功能,以区别是否是药物的副作用。还有一种罕见的MMI导致的胆汁淤积性肝病,肝脏活体检查肝细胞结构存在,小胆管内可见胆汁淤积,外周有轻度炎症,停药后本症可以完全恢复。

该患者在院外应用抗甲状腺药物后出现了肝功损伤及白细胞减少,所以不适合长期应用抗甲状腺药物治疗。另外,甲状腺不大,而且甲亢性心脏病、心力衰竭诊断明确,其心功能也不能耐受手术治疗,所以也未选择手术治疗,而是应用了131I治疗。

2﹒β受体阻断剂

β受体阻断剂常用于甲亢患者的辅助治疗,控制甲亢的症状,减慢心率。甲状腺激素可以增加肾上腺能受体的敏感性,β受体阻断剂从受体部位阻断儿茶酚胺的作用,减轻甲状腺毒症的症状;在ATD作用完全发挥以前控制甲状腺毒症的症状。β受体阻断剂还具有抑制外周组织T4转换为T3的作用,还可阻断甲状腺激素对心肌的直接作用。目前使用最广泛的β受体阻断剂是普萘洛尔,1日20~80mg,每6~8小时1次。哮喘和慢性阻塞性肺疾病禁用;甲亢妊娠女性患者慎用;心脏传导阻滞和充血性心力衰竭禁用,但严重心动过速导致的心力衰竭可以使用。而该患者院外曾经诊断心力衰竭,并应用强心利尿治疗,故应用酒石酸美托洛尔1次25mg,1日2次,而未选择对心肌有负性肌力作用的普萘洛尔治疗。

3﹒保肝治疗

抗甲状腺药物常见的副作用之一是对肝脏的损伤,可以引起转氨酶升高和淤胆,其中甲巯咪唑主要是引起淤胆,该患者应用甲巯咪唑后出现了肝功能异常,但属于轻度,所以未停用抗甲状腺药物,但同时应用了保肝药物(复方甘草酸单铵和复合辅酶)进行保肝治疗。

4﹒强心利尿

患者曾经在院外应用了强心利尿治疗,所以刚住院时延续了院外的治疗,后经进一步进行心脏超声检查,BNP测定,并请心内科会诊后,考虑心功能正常,故停用地高辛,但继续应用利尿剂呋塞米、螺内酯和盐酸多巴胺,以减轻心脏负荷。

5﹒升白细胞治疗

刚入院时患者虽有白细胞减少,但白细胞总数仍在3.0×109/L以上,所以只口服了利可君以升高白细胞,但在之后的治疗过程中,白细胞低至2.31 ×109/L,故应用了重组人粒细胞刺激因子皮下注射,以快速升高白细胞,避免因严重白细胞减低造成感染,加重病情,同时尽快提高白细胞也是为下一步131I治疗甲亢创造条件。

重组人粒细胞刺激因子的常见副作用为骨痛及关节肌肉酸痛,多出现于用药后白细胞迅速上升至正常水平或白细胞较前明显升高的患者,通常无须临床处理。用药期间应密切注意尿道、尿量有无变化,是否出现水肿等症状,一旦出现异常,应立即给予适当治疗。应用期间应定期监测血常规,以免造成中性粒细胞过多,如周围白细胞升至(2~5)×109/L时可停药;如≥10 ×109/L或周围血出现幼稚细胞时,应立即停药。用药期间还应监测肾功能、尿常规。

6﹒治疗布氏杆菌病

由于布氏杆菌寄殖于宿主细胞内,故应选用在细胞内浓度高的有效抗菌药,由于单药治疗复发率高,因此宜联合用药。世界卫生组织推荐的治疗方案为利福平,1日600~900mg,联用多西环素1日200mg,疗程6周。羊、猪型感染者以四环素与链霉素合用为宜,四环素1日2g,分4次服用;链霉素1日1g,分2次肌内注射,3周为1疗程。发热一般于用药后3~5日内消退,此时剂量可减为1日1.5g。一般采用2个疗程,每次间隔5~7日。布氏杆菌病急性期最有效药物为四环素,1次0.25~0.5g,1日4次,连服4周为1个疗程。停1周后可依病情再用药1~2个疗程。必要时可以加用链霉素。本例患者选用四环素治疗布氏杆菌病,临床应用时注意监护:①四环素易致肝毒性,通常为脂肪肝变性,妊娠期妇女、原有肝功能损害的患者易发生肝毒性,与其他肝毒性药物合用时可加重肝损害,与强利尿药如呋塞米等药物合用时可加重肾功能损害。长期用药期间应定期随访检查血常规以及肝、肾功能;②本例患者给予泮托拉唑抑酸治疗,由于胃内p H增高,可使四环素吸收减少,活性减低,故四环素与泮托拉唑给药应间隔1~3小时。

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (17)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1824246, encodeId=fc0a182424622, content=<a href='/topic/show?id=56a932e7800' target=_blank style='color:#2F92EE;'>#副作用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32778, encryptionId=56a932e7800, topicName=副作用)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f0715, createdName=showtest, createdTime=Thu Feb 08 10:30:00 CST 2018, time=2018-02-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=302183, encodeId=49e4302183ad, content=讲的很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0ad01994393, createdName=溜溜梅不酸, createdTime=Mon Apr 02 23:57:53 CST 2018, time=2018-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2035039, encodeId=14e0203503983, content=<a href='/topic/show?id=ad5955450d7' target=_blank style='color:#2F92EE;'>#抗甲状腺药物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55450, encryptionId=ad5955450d7, topicName=抗甲状腺药物)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f378286, createdName=shalley66, createdTime=Mon Jan 22 03:30:00 CST 2018, time=2018-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1798659, encodeId=d7c01e98659d6, content=<a href='/topic/show?id=fa5669e524a' target=_blank style='color:#2F92EE;'>#甲亢性心脏病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69752, encryptionId=fa5669e524a, topicName=甲亢性心脏病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7d74253, createdName=wangtianj2007@, createdTime=Tue Mar 06 07:30:00 CST 2018, time=2018-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2039590, encodeId=f945203959072, content=<a href='/topic/show?id=7ae88244a6' target=_blank style='color:#2F92EE;'>#Graves#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8244, encryptionId=7ae88244a6, topicName=Graves)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f49517, createdName=xinmeili, createdTime=Tue Jun 05 21:30:00 CST 2018, time=2018-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=223807, encodeId=4de122380ead, content=好文,值得点赞!认真学习,应用于实践!谢谢分享给广大同好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Wed Jul 19 08:13:22 CST 2017, time=2017-07-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222988, encodeId=7303222988ed, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c0a61971598, createdName=往日如昨, createdTime=Sun Jul 16 22:52:52 CST 2017, time=2017-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1464159, encodeId=5bf31464159b5, content=<a href='/topic/show?id=9a0982481a' target=_blank style='color:#2F92EE;'>#Graves病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=128, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8248, encryptionId=9a0982481a, topicName=Graves病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=25146601811, createdName=aliceclz, createdTime=Sun Jul 16 14:30:00 CST 2017, time=2017-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222823, encodeId=87582228238d, content=认真学习,把间接经验应用到临床实践中去,然后再总结出新思路。给点赞啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Sun Jul 16 08:34:32 CST 2017, time=2017-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222707, encodeId=9054222e07f3, content=学了。。。。。。。。。。。。。。。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Neru1qt53a14aACuSzg3TZhkTcsPYVibyHibhTZ5L4k9qIBWiaej4lgomIsGptf8N16E4mTuIq2DVdJXjPjmwZKrLib/0, createdBy=5a0f2055853, createdName=135****7952平儿, createdTime=Sun Jul 16 00:07:12 CST 2017, time=2017-07-16, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=1824246, encodeId=fc0a182424622, content=<a href='/topic/show?id=56a932e7800' target=_blank style='color:#2F92EE;'>#副作用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32778, encryptionId=56a932e7800, topicName=副作用)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f0715, createdName=showtest, createdTime=Thu Feb 08 10:30:00 CST 2018, time=2018-02-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=302183, encodeId=49e4302183ad, content=讲的很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0ad01994393, createdName=溜溜梅不酸, createdTime=Mon Apr 02 23:57:53 CST 2018, time=2018-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2035039, encodeId=14e0203503983, content=<a href='/topic/show?id=ad5955450d7' target=_blank style='color:#2F92EE;'>#抗甲状腺药物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55450, encryptionId=ad5955450d7, topicName=抗甲状腺药物)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f378286, createdName=shalley66, createdTime=Mon Jan 22 03:30:00 CST 2018, time=2018-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1798659, encodeId=d7c01e98659d6, content=<a href='/topic/show?id=fa5669e524a' target=_blank style='color:#2F92EE;'>#甲亢性心脏病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69752, encryptionId=fa5669e524a, topicName=甲亢性心脏病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7d74253, createdName=wangtianj2007@, createdTime=Tue Mar 06 07:30:00 CST 2018, time=2018-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2039590, encodeId=f945203959072, content=<a href='/topic/show?id=7ae88244a6' target=_blank style='color:#2F92EE;'>#Graves#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8244, encryptionId=7ae88244a6, topicName=Graves)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f49517, createdName=xinmeili, createdTime=Tue Jun 05 21:30:00 CST 2018, time=2018-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=223807, encodeId=4de122380ead, content=好文,值得点赞!认真学习,应用于实践!谢谢分享给广大同好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Wed Jul 19 08:13:22 CST 2017, time=2017-07-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222988, encodeId=7303222988ed, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c0a61971598, createdName=往日如昨, createdTime=Sun Jul 16 22:52:52 CST 2017, time=2017-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1464159, encodeId=5bf31464159b5, content=<a href='/topic/show?id=9a0982481a' target=_blank style='color:#2F92EE;'>#Graves病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=128, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8248, encryptionId=9a0982481a, topicName=Graves病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=25146601811, createdName=aliceclz, createdTime=Sun Jul 16 14:30:00 CST 2017, time=2017-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222823, encodeId=87582228238d, content=认真学习,把间接经验应用到临床实践中去,然后再总结出新思路。给点赞啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Sun Jul 16 08:34:32 CST 2017, time=2017-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222707, encodeId=9054222e07f3, content=学了。。。。。。。。。。。。。。。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Neru1qt53a14aACuSzg3TZhkTcsPYVibyHibhTZ5L4k9qIBWiaej4lgomIsGptf8N16E4mTuIq2DVdJXjPjmwZKrLib/0, createdBy=5a0f2055853, createdName=135****7952平儿, createdTime=Sun Jul 16 00:07:12 CST 2017, time=2017-07-16, status=1, ipAttribution=)]
    2018-04-02 溜溜梅不酸

    讲的很好

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1824246, encodeId=fc0a182424622, content=<a href='/topic/show?id=56a932e7800' target=_blank style='color:#2F92EE;'>#副作用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32778, encryptionId=56a932e7800, topicName=副作用)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f0715, createdName=showtest, createdTime=Thu Feb 08 10:30:00 CST 2018, time=2018-02-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=302183, encodeId=49e4302183ad, content=讲的很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0ad01994393, createdName=溜溜梅不酸, createdTime=Mon Apr 02 23:57:53 CST 2018, time=2018-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2035039, encodeId=14e0203503983, content=<a href='/topic/show?id=ad5955450d7' target=_blank style='color:#2F92EE;'>#抗甲状腺药物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55450, encryptionId=ad5955450d7, topicName=抗甲状腺药物)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f378286, createdName=shalley66, createdTime=Mon Jan 22 03:30:00 CST 2018, time=2018-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1798659, encodeId=d7c01e98659d6, content=<a href='/topic/show?id=fa5669e524a' target=_blank style='color:#2F92EE;'>#甲亢性心脏病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69752, encryptionId=fa5669e524a, topicName=甲亢性心脏病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7d74253, createdName=wangtianj2007@, createdTime=Tue Mar 06 07:30:00 CST 2018, time=2018-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2039590, encodeId=f945203959072, content=<a href='/topic/show?id=7ae88244a6' target=_blank style='color:#2F92EE;'>#Graves#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8244, encryptionId=7ae88244a6, topicName=Graves)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f49517, createdName=xinmeili, createdTime=Tue Jun 05 21:30:00 CST 2018, time=2018-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=223807, encodeId=4de122380ead, content=好文,值得点赞!认真学习,应用于实践!谢谢分享给广大同好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Wed Jul 19 08:13:22 CST 2017, time=2017-07-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222988, encodeId=7303222988ed, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c0a61971598, createdName=往日如昨, createdTime=Sun Jul 16 22:52:52 CST 2017, time=2017-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1464159, encodeId=5bf31464159b5, content=<a href='/topic/show?id=9a0982481a' target=_blank style='color:#2F92EE;'>#Graves病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=128, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8248, encryptionId=9a0982481a, topicName=Graves病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=25146601811, createdName=aliceclz, createdTime=Sun Jul 16 14:30:00 CST 2017, time=2017-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222823, encodeId=87582228238d, content=认真学习,把间接经验应用到临床实践中去,然后再总结出新思路。给点赞啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Sun Jul 16 08:34:32 CST 2017, time=2017-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222707, encodeId=9054222e07f3, content=学了。。。。。。。。。。。。。。。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Neru1qt53a14aACuSzg3TZhkTcsPYVibyHibhTZ5L4k9qIBWiaej4lgomIsGptf8N16E4mTuIq2DVdJXjPjmwZKrLib/0, createdBy=5a0f2055853, createdName=135****7952平儿, createdTime=Sun Jul 16 00:07:12 CST 2017, time=2017-07-16, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=1824246, encodeId=fc0a182424622, content=<a href='/topic/show?id=56a932e7800' target=_blank style='color:#2F92EE;'>#副作用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32778, encryptionId=56a932e7800, topicName=副作用)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f0715, createdName=showtest, createdTime=Thu Feb 08 10:30:00 CST 2018, time=2018-02-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=302183, encodeId=49e4302183ad, content=讲的很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0ad01994393, createdName=溜溜梅不酸, createdTime=Mon Apr 02 23:57:53 CST 2018, time=2018-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2035039, encodeId=14e0203503983, content=<a href='/topic/show?id=ad5955450d7' target=_blank style='color:#2F92EE;'>#抗甲状腺药物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55450, encryptionId=ad5955450d7, topicName=抗甲状腺药物)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f378286, createdName=shalley66, createdTime=Mon Jan 22 03:30:00 CST 2018, time=2018-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1798659, encodeId=d7c01e98659d6, content=<a href='/topic/show?id=fa5669e524a' target=_blank style='color:#2F92EE;'>#甲亢性心脏病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69752, encryptionId=fa5669e524a, topicName=甲亢性心脏病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7d74253, createdName=wangtianj2007@, createdTime=Tue Mar 06 07:30:00 CST 2018, time=2018-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2039590, encodeId=f945203959072, content=<a href='/topic/show?id=7ae88244a6' target=_blank style='color:#2F92EE;'>#Graves#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8244, encryptionId=7ae88244a6, topicName=Graves)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f49517, createdName=xinmeili, createdTime=Tue Jun 05 21:30:00 CST 2018, time=2018-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=223807, encodeId=4de122380ead, content=好文,值得点赞!认真学习,应用于实践!谢谢分享给广大同好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Wed Jul 19 08:13:22 CST 2017, time=2017-07-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222988, encodeId=7303222988ed, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c0a61971598, createdName=往日如昨, createdTime=Sun Jul 16 22:52:52 CST 2017, time=2017-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1464159, encodeId=5bf31464159b5, content=<a href='/topic/show?id=9a0982481a' target=_blank style='color:#2F92EE;'>#Graves病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=128, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8248, encryptionId=9a0982481a, topicName=Graves病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=25146601811, createdName=aliceclz, createdTime=Sun Jul 16 14:30:00 CST 2017, time=2017-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222823, encodeId=87582228238d, content=认真学习,把间接经验应用到临床实践中去,然后再总结出新思路。给点赞啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Sun Jul 16 08:34:32 CST 2017, time=2017-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222707, encodeId=9054222e07f3, content=学了。。。。。。。。。。。。。。。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Neru1qt53a14aACuSzg3TZhkTcsPYVibyHibhTZ5L4k9qIBWiaej4lgomIsGptf8N16E4mTuIq2DVdJXjPjmwZKrLib/0, createdBy=5a0f2055853, createdName=135****7952平儿, createdTime=Sun Jul 16 00:07:12 CST 2017, time=2017-07-16, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1824246, encodeId=fc0a182424622, content=<a href='/topic/show?id=56a932e7800' target=_blank style='color:#2F92EE;'>#副作用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32778, encryptionId=56a932e7800, topicName=副作用)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f0715, createdName=showtest, createdTime=Thu Feb 08 10:30:00 CST 2018, time=2018-02-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=302183, encodeId=49e4302183ad, content=讲的很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0ad01994393, createdName=溜溜梅不酸, createdTime=Mon Apr 02 23:57:53 CST 2018, time=2018-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2035039, encodeId=14e0203503983, content=<a href='/topic/show?id=ad5955450d7' target=_blank style='color:#2F92EE;'>#抗甲状腺药物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55450, encryptionId=ad5955450d7, topicName=抗甲状腺药物)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f378286, createdName=shalley66, createdTime=Mon Jan 22 03:30:00 CST 2018, time=2018-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1798659, encodeId=d7c01e98659d6, content=<a href='/topic/show?id=fa5669e524a' target=_blank style='color:#2F92EE;'>#甲亢性心脏病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69752, encryptionId=fa5669e524a, topicName=甲亢性心脏病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7d74253, createdName=wangtianj2007@, createdTime=Tue Mar 06 07:30:00 CST 2018, time=2018-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2039590, encodeId=f945203959072, content=<a href='/topic/show?id=7ae88244a6' target=_blank style='color:#2F92EE;'>#Graves#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8244, encryptionId=7ae88244a6, topicName=Graves)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f49517, createdName=xinmeili, createdTime=Tue Jun 05 21:30:00 CST 2018, time=2018-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=223807, encodeId=4de122380ead, content=好文,值得点赞!认真学习,应用于实践!谢谢分享给广大同好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Wed Jul 19 08:13:22 CST 2017, time=2017-07-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222988, encodeId=7303222988ed, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c0a61971598, createdName=往日如昨, createdTime=Sun Jul 16 22:52:52 CST 2017, time=2017-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1464159, encodeId=5bf31464159b5, content=<a href='/topic/show?id=9a0982481a' target=_blank style='color:#2F92EE;'>#Graves病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=128, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8248, encryptionId=9a0982481a, topicName=Graves病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=25146601811, createdName=aliceclz, createdTime=Sun Jul 16 14:30:00 CST 2017, time=2017-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222823, encodeId=87582228238d, content=认真学习,把间接经验应用到临床实践中去,然后再总结出新思路。给点赞啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Sun Jul 16 08:34:32 CST 2017, time=2017-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222707, encodeId=9054222e07f3, content=学了。。。。。。。。。。。。。。。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Neru1qt53a14aACuSzg3TZhkTcsPYVibyHibhTZ5L4k9qIBWiaej4lgomIsGptf8N16E4mTuIq2DVdJXjPjmwZKrLib/0, createdBy=5a0f2055853, createdName=135****7952平儿, createdTime=Sun Jul 16 00:07:12 CST 2017, time=2017-07-16, status=1, ipAttribution=)]
    2018-06-05 xinmeili
  6. [GetPortalCommentsPageByObjectIdResponse(id=1824246, encodeId=fc0a182424622, content=<a href='/topic/show?id=56a932e7800' target=_blank style='color:#2F92EE;'>#副作用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32778, encryptionId=56a932e7800, topicName=副作用)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f0715, createdName=showtest, createdTime=Thu Feb 08 10:30:00 CST 2018, time=2018-02-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=302183, encodeId=49e4302183ad, content=讲的很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0ad01994393, createdName=溜溜梅不酸, createdTime=Mon Apr 02 23:57:53 CST 2018, time=2018-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2035039, encodeId=14e0203503983, content=<a href='/topic/show?id=ad5955450d7' target=_blank style='color:#2F92EE;'>#抗甲状腺药物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55450, encryptionId=ad5955450d7, topicName=抗甲状腺药物)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f378286, createdName=shalley66, createdTime=Mon Jan 22 03:30:00 CST 2018, time=2018-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1798659, encodeId=d7c01e98659d6, content=<a href='/topic/show?id=fa5669e524a' target=_blank style='color:#2F92EE;'>#甲亢性心脏病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69752, encryptionId=fa5669e524a, topicName=甲亢性心脏病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7d74253, createdName=wangtianj2007@, createdTime=Tue Mar 06 07:30:00 CST 2018, time=2018-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2039590, encodeId=f945203959072, content=<a href='/topic/show?id=7ae88244a6' target=_blank style='color:#2F92EE;'>#Graves#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8244, encryptionId=7ae88244a6, topicName=Graves)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f49517, createdName=xinmeili, createdTime=Tue Jun 05 21:30:00 CST 2018, time=2018-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=223807, encodeId=4de122380ead, content=好文,值得点赞!认真学习,应用于实践!谢谢分享给广大同好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Wed Jul 19 08:13:22 CST 2017, time=2017-07-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222988, encodeId=7303222988ed, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c0a61971598, createdName=往日如昨, createdTime=Sun Jul 16 22:52:52 CST 2017, time=2017-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1464159, encodeId=5bf31464159b5, content=<a href='/topic/show?id=9a0982481a' target=_blank style='color:#2F92EE;'>#Graves病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=128, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8248, encryptionId=9a0982481a, topicName=Graves病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=25146601811, createdName=aliceclz, createdTime=Sun Jul 16 14:30:00 CST 2017, time=2017-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222823, encodeId=87582228238d, content=认真学习,把间接经验应用到临床实践中去,然后再总结出新思路。给点赞啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Sun Jul 16 08:34:32 CST 2017, time=2017-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222707, encodeId=9054222e07f3, content=学了。。。。。。。。。。。。。。。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Neru1qt53a14aACuSzg3TZhkTcsPYVibyHibhTZ5L4k9qIBWiaej4lgomIsGptf8N16E4mTuIq2DVdJXjPjmwZKrLib/0, createdBy=5a0f2055853, createdName=135****7952平儿, createdTime=Sun Jul 16 00:07:12 CST 2017, time=2017-07-16, status=1, ipAttribution=)]
    2017-07-19 ylzr123

    好文,值得点赞!认真学习,应用于实践!谢谢分享给广大同好!

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1824246, encodeId=fc0a182424622, content=<a href='/topic/show?id=56a932e7800' target=_blank style='color:#2F92EE;'>#副作用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32778, encryptionId=56a932e7800, topicName=副作用)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f0715, createdName=showtest, createdTime=Thu Feb 08 10:30:00 CST 2018, time=2018-02-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=302183, encodeId=49e4302183ad, content=讲的很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0ad01994393, createdName=溜溜梅不酸, createdTime=Mon Apr 02 23:57:53 CST 2018, time=2018-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2035039, encodeId=14e0203503983, content=<a href='/topic/show?id=ad5955450d7' target=_blank style='color:#2F92EE;'>#抗甲状腺药物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55450, encryptionId=ad5955450d7, topicName=抗甲状腺药物)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f378286, createdName=shalley66, createdTime=Mon Jan 22 03:30:00 CST 2018, time=2018-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1798659, encodeId=d7c01e98659d6, content=<a href='/topic/show?id=fa5669e524a' target=_blank style='color:#2F92EE;'>#甲亢性心脏病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69752, encryptionId=fa5669e524a, topicName=甲亢性心脏病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7d74253, createdName=wangtianj2007@, createdTime=Tue Mar 06 07:30:00 CST 2018, time=2018-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2039590, encodeId=f945203959072, content=<a href='/topic/show?id=7ae88244a6' target=_blank style='color:#2F92EE;'>#Graves#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8244, encryptionId=7ae88244a6, topicName=Graves)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f49517, createdName=xinmeili, createdTime=Tue Jun 05 21:30:00 CST 2018, time=2018-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=223807, encodeId=4de122380ead, content=好文,值得点赞!认真学习,应用于实践!谢谢分享给广大同好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Wed Jul 19 08:13:22 CST 2017, time=2017-07-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222988, encodeId=7303222988ed, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c0a61971598, createdName=往日如昨, createdTime=Sun Jul 16 22:52:52 CST 2017, time=2017-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1464159, encodeId=5bf31464159b5, content=<a href='/topic/show?id=9a0982481a' target=_blank style='color:#2F92EE;'>#Graves病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=128, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8248, encryptionId=9a0982481a, topicName=Graves病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=25146601811, createdName=aliceclz, createdTime=Sun Jul 16 14:30:00 CST 2017, time=2017-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222823, encodeId=87582228238d, content=认真学习,把间接经验应用到临床实践中去,然后再总结出新思路。给点赞啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Sun Jul 16 08:34:32 CST 2017, time=2017-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222707, encodeId=9054222e07f3, content=学了。。。。。。。。。。。。。。。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Neru1qt53a14aACuSzg3TZhkTcsPYVibyHibhTZ5L4k9qIBWiaej4lgomIsGptf8N16E4mTuIq2DVdJXjPjmwZKrLib/0, createdBy=5a0f2055853, createdName=135****7952平儿, createdTime=Sun Jul 16 00:07:12 CST 2017, time=2017-07-16, status=1, ipAttribution=)]
    2017-07-16 往日如昨

    学习了谢谢分享

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1824246, encodeId=fc0a182424622, content=<a href='/topic/show?id=56a932e7800' target=_blank style='color:#2F92EE;'>#副作用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32778, encryptionId=56a932e7800, topicName=副作用)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f0715, createdName=showtest, createdTime=Thu Feb 08 10:30:00 CST 2018, time=2018-02-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=302183, encodeId=49e4302183ad, content=讲的很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0ad01994393, createdName=溜溜梅不酸, createdTime=Mon Apr 02 23:57:53 CST 2018, time=2018-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2035039, encodeId=14e0203503983, content=<a href='/topic/show?id=ad5955450d7' target=_blank style='color:#2F92EE;'>#抗甲状腺药物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55450, encryptionId=ad5955450d7, topicName=抗甲状腺药物)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f378286, createdName=shalley66, createdTime=Mon Jan 22 03:30:00 CST 2018, time=2018-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1798659, encodeId=d7c01e98659d6, content=<a href='/topic/show?id=fa5669e524a' target=_blank style='color:#2F92EE;'>#甲亢性心脏病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69752, encryptionId=fa5669e524a, topicName=甲亢性心脏病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7d74253, createdName=wangtianj2007@, createdTime=Tue Mar 06 07:30:00 CST 2018, time=2018-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2039590, encodeId=f945203959072, content=<a href='/topic/show?id=7ae88244a6' target=_blank style='color:#2F92EE;'>#Graves#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8244, encryptionId=7ae88244a6, topicName=Graves)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f49517, createdName=xinmeili, createdTime=Tue Jun 05 21:30:00 CST 2018, time=2018-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=223807, encodeId=4de122380ead, content=好文,值得点赞!认真学习,应用于实践!谢谢分享给广大同好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Wed Jul 19 08:13:22 CST 2017, time=2017-07-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222988, encodeId=7303222988ed, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c0a61971598, createdName=往日如昨, createdTime=Sun Jul 16 22:52:52 CST 2017, time=2017-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1464159, encodeId=5bf31464159b5, content=<a href='/topic/show?id=9a0982481a' target=_blank style='color:#2F92EE;'>#Graves病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=128, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8248, encryptionId=9a0982481a, topicName=Graves病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=25146601811, createdName=aliceclz, createdTime=Sun Jul 16 14:30:00 CST 2017, time=2017-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222823, encodeId=87582228238d, content=认真学习,把间接经验应用到临床实践中去,然后再总结出新思路。给点赞啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Sun Jul 16 08:34:32 CST 2017, time=2017-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222707, encodeId=9054222e07f3, content=学了。。。。。。。。。。。。。。。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Neru1qt53a14aACuSzg3TZhkTcsPYVibyHibhTZ5L4k9qIBWiaej4lgomIsGptf8N16E4mTuIq2DVdJXjPjmwZKrLib/0, createdBy=5a0f2055853, createdName=135****7952平儿, createdTime=Sun Jul 16 00:07:12 CST 2017, time=2017-07-16, status=1, ipAttribution=)]
  9. [GetPortalCommentsPageByObjectIdResponse(id=1824246, encodeId=fc0a182424622, content=<a href='/topic/show?id=56a932e7800' target=_blank style='color:#2F92EE;'>#副作用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32778, encryptionId=56a932e7800, topicName=副作用)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f0715, createdName=showtest, createdTime=Thu Feb 08 10:30:00 CST 2018, time=2018-02-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=302183, encodeId=49e4302183ad, content=讲的很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0ad01994393, createdName=溜溜梅不酸, createdTime=Mon Apr 02 23:57:53 CST 2018, time=2018-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2035039, encodeId=14e0203503983, content=<a href='/topic/show?id=ad5955450d7' target=_blank style='color:#2F92EE;'>#抗甲状腺药物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55450, encryptionId=ad5955450d7, topicName=抗甲状腺药物)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f378286, createdName=shalley66, createdTime=Mon Jan 22 03:30:00 CST 2018, time=2018-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1798659, encodeId=d7c01e98659d6, content=<a href='/topic/show?id=fa5669e524a' target=_blank style='color:#2F92EE;'>#甲亢性心脏病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69752, encryptionId=fa5669e524a, topicName=甲亢性心脏病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7d74253, createdName=wangtianj2007@, createdTime=Tue Mar 06 07:30:00 CST 2018, time=2018-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2039590, encodeId=f945203959072, content=<a href='/topic/show?id=7ae88244a6' target=_blank style='color:#2F92EE;'>#Graves#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8244, encryptionId=7ae88244a6, topicName=Graves)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f49517, createdName=xinmeili, createdTime=Tue Jun 05 21:30:00 CST 2018, time=2018-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=223807, encodeId=4de122380ead, content=好文,值得点赞!认真学习,应用于实践!谢谢分享给广大同好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Wed Jul 19 08:13:22 CST 2017, time=2017-07-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222988, encodeId=7303222988ed, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c0a61971598, createdName=往日如昨, createdTime=Sun Jul 16 22:52:52 CST 2017, time=2017-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1464159, encodeId=5bf31464159b5, content=<a href='/topic/show?id=9a0982481a' target=_blank style='color:#2F92EE;'>#Graves病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=128, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8248, encryptionId=9a0982481a, topicName=Graves病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=25146601811, createdName=aliceclz, createdTime=Sun Jul 16 14:30:00 CST 2017, time=2017-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222823, encodeId=87582228238d, content=认真学习,把间接经验应用到临床实践中去,然后再总结出新思路。给点赞啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Sun Jul 16 08:34:32 CST 2017, time=2017-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222707, encodeId=9054222e07f3, content=学了。。。。。。。。。。。。。。。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Neru1qt53a14aACuSzg3TZhkTcsPYVibyHibhTZ5L4k9qIBWiaej4lgomIsGptf8N16E4mTuIq2DVdJXjPjmwZKrLib/0, createdBy=5a0f2055853, createdName=135****7952平儿, createdTime=Sun Jul 16 00:07:12 CST 2017, time=2017-07-16, status=1, ipAttribution=)]
    2017-07-16 ylzr123

    认真学习,把间接经验应用到临床实践中去,然后再总结出新思路。给点赞啦

    0

  10. [GetPortalCommentsPageByObjectIdResponse(id=1824246, encodeId=fc0a182424622, content=<a href='/topic/show?id=56a932e7800' target=_blank style='color:#2F92EE;'>#副作用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32778, encryptionId=56a932e7800, topicName=副作用)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f0715, createdName=showtest, createdTime=Thu Feb 08 10:30:00 CST 2018, time=2018-02-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=302183, encodeId=49e4302183ad, content=讲的很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0ad01994393, createdName=溜溜梅不酸, createdTime=Mon Apr 02 23:57:53 CST 2018, time=2018-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2035039, encodeId=14e0203503983, content=<a href='/topic/show?id=ad5955450d7' target=_blank style='color:#2F92EE;'>#抗甲状腺药物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55450, encryptionId=ad5955450d7, topicName=抗甲状腺药物)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f378286, createdName=shalley66, createdTime=Mon Jan 22 03:30:00 CST 2018, time=2018-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1798659, encodeId=d7c01e98659d6, content=<a href='/topic/show?id=fa5669e524a' target=_blank style='color:#2F92EE;'>#甲亢性心脏病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69752, encryptionId=fa5669e524a, topicName=甲亢性心脏病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7d74253, createdName=wangtianj2007@, createdTime=Tue Mar 06 07:30:00 CST 2018, time=2018-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2039590, encodeId=f945203959072, content=<a href='/topic/show?id=7ae88244a6' target=_blank style='color:#2F92EE;'>#Graves#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8244, encryptionId=7ae88244a6, topicName=Graves)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f49517, createdName=xinmeili, createdTime=Tue Jun 05 21:30:00 CST 2018, time=2018-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=223807, encodeId=4de122380ead, content=好文,值得点赞!认真学习,应用于实践!谢谢分享给广大同好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Wed Jul 19 08:13:22 CST 2017, time=2017-07-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222988, encodeId=7303222988ed, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c0a61971598, createdName=往日如昨, createdTime=Sun Jul 16 22:52:52 CST 2017, time=2017-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1464159, encodeId=5bf31464159b5, content=<a href='/topic/show?id=9a0982481a' target=_blank style='color:#2F92EE;'>#Graves病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=128, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8248, encryptionId=9a0982481a, topicName=Graves病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=25146601811, createdName=aliceclz, createdTime=Sun Jul 16 14:30:00 CST 2017, time=2017-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222823, encodeId=87582228238d, content=认真学习,把间接经验应用到临床实践中去,然后再总结出新思路。给点赞啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Sun Jul 16 08:34:32 CST 2017, time=2017-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=222707, encodeId=9054222e07f3, content=学了。。。。。。。。。。。。。。。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Neru1qt53a14aACuSzg3TZhkTcsPYVibyHibhTZ5L4k9qIBWiaej4lgomIsGptf8N16E4mTuIq2DVdJXjPjmwZKrLib/0, createdBy=5a0f2055853, createdName=135****7952平儿, createdTime=Sun Jul 16 00:07:12 CST 2017, time=2017-07-16, status=1, ipAttribution=)]
    2017-07-16 135****7952平儿

    学了。。。。。。。。。。。。。。。。。

    0

相关资讯

JCEM:抗甲状腺药物治疗GD复发率高

有多种治疗方案可用于Graves病(GD),包括抗甲状腺药物(ATDs)、放射性碘(RAI)和甲状腺切除术。为了确定各种治疗方案的复发率,以及现有的关于ATDs不良反应的数据,来自美国马约诊所Rebecca S Bahn教授及其团队进行了一项研究,该研究发现ATDs治疗GD复发率高。该研究结果在线发表在2013年7月3日的《临床内分泌代谢杂志》(The journal of clinical en

J Med Case Reports:甲状腺全切术后的Graves病

甲状腺切除术后的甲状腺毒症主要是医源性的。较少见的是高功能甲状腺组织的残留或者异位甲状腺组织所致。研究人员报道的这一病例是非毒性甲状腺肿行甲状腺全切后出现持续7年的纵膈甲状腺导致的Graves病。一位67岁的白人妇女出现心悸,乏力,体重下降。她在60岁时因非毒性结节性甲状腺肿行甲状腺全切术,当时无恶变倾向。术后服用左旋甲状腺素100μg/天。她出现心动过速,无颈部肿块和眼部损害,促甲状腺素水平被抑

Clin Endocrinol:硒缺乏或与Graves病有关

硒缺乏可能在自身免疫性甲状腺疾病的发生和发展中发挥重要作用。为了在丹麦新诊断自身免疫性甲状腺疾病患者和对照受试者中比较血清硒含量(S–Se),来自丹麦奥尔胡斯大学奥尔堡医院Inge Bülow Pedersen教授及其团队进行了一项研究,该研究发现新诊断GD患者和AIH患者的S–Se显著低于随机对照者。该研究结果发表在2013年10月Clinical Endocrinolo

Thyroid:病毒感染或参与Graves病起病

不同GD患者甲状腺组织CD4+和CD8+ T细胞、以及浆细胞的比较 极少有研究系统性调查Graves病起始时免疫细胞渗入甲状腺组织。病毒在自身免疫性甲状腺疾病发病机制中的作用仍有争议。为了分析Graves病患者病毒感染迹象有关的炎症反应,来自挪威奥斯陆大学附属医院Sara Salehi Hammerstad教授及其团队进行了一项研究,该研究发现长期GD期间CD8+ T细胞增加,GD早期MxA

Baidu
map
Baidu
map
Baidu
map