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CODHy AP 速递|多机制调节糖脂代谢,中医药在糖尿病防治中的临床疗效

2022-06-03 MedSci原创 MedSci原创

 

     “过去的30年,我国糖尿病患病率急剧增长,给人民带来了严峻的健康和经济负担”中国内分泌代谢病学专家、中国工程院宁光院士在近日举行的第十届亚太地区糖尿病、肥胖和高血压从辩论到共识大会(CODHy AP)上强调,生活方式、老龄化和肥胖是我国糖尿病发病率增加的主要危险因素,而肥胖相关的胰岛素抵抗是我国糖尿病更重要的病理生理机制。因此,需要发现更多可预测糖尿病的因素,这样可以为早期的发现、诊断预防糖尿病做出贡献。

      因疫情原因,本届CODHy AP会议采用全程线上直播+云展览的模式在线开启。作为大会发起人,宁光院士携手以色列国家糖尿病委员会主席Itamar Raz教授,以及2006年诺贝尔化学奖获得者、斯坦福大学Roger Kornberg教授、中华医学会内分泌学分会候任主任委员王卫庆教授等众多享誉国内外的内分泌代谢病领域顶级专家学者齐聚云端,就糖尿病、肥胖和高血压的具体问题和难点进行了深入探讨,也让全球观众能近距离地感受到了国际化内分泌专业会议的魅力。

      会上,中医药防治糖尿病成果得到与会嘉宾的广泛关注。大会主席王卫庆教授结合基础和临床研究相关成果,介绍了中医药在糖尿病治疗中的作用和优势。本文现将王卫庆教授分享内容整理如下,以飨读者。

 

       我国糖尿病患病率逐年增高严重影响生存质量

      糖尿病是我国重点防控的四大慢性病之一。2010年,由宁光院士牵头与国家疾控中心(CDC)合作的、涵盖10万人的糖尿病流行病学调查显示,我国糖尿病患病率约为10%。据最新调查显示[1],中国目前的糖尿病患者群已超过1.4亿。国际糖尿病联盟(IDF)预估,到2045年,中国的糖尿病患者预计达到1.7亿。临床上,若血糖控制不佳,糖尿病患者易导致并发症的发生,包括心血管疾病、视网膜病变、糖尿病肾病、血管神经病变等,严重影响糖尿病患者生活质量、甚至危害患者生命。

      王卫庆教授在报告中指出,面对我国糖尿病患病的实际情况,医护人员应充分认识到疾病的严重性,进一步加强对糖尿病患者及潜在人群进行引导、教育,有效改善糖尿病患者的长期治疗结局,从而避免或降低糖尿病并发症的产生。

 

       中医药助力糖尿病治疗为临床提供更优选择

       中医药治疗糖尿病历史悠久。近年来,中医药在防治糖尿病及其并发症方面取得了良好的效果。2021年4月,中华医学会糖尿病学分会发表的《中国2型糖尿病防治指南(2020年版)》[2]将中医药治疗作为糖尿病治疗的重要组成部分。

      2020版指南中第19章专门论述了糖尿病的中医药治疗,并推荐对于2型糖尿病气阴两虚证,在应用二甲双胍等降糖药物的基础上,可加服津力达颗粒。

 

 

      津力达颗粒是在络病理论指导下研发的防治2型糖尿病及其并发症的创新专利药物。王卫庆教授介绍,药效研究表明津力达颗粒可以调节糖脂代谢,保护胰岛β细胞,改善胰岛素抵抗,改善胰岛微循环,改善氧化应激等。临床研究表明津力达颗粒可以改善糖耐量异常、降低2型糖尿病发生风险,降低糖化血红蛋白(HbA1c),减轻体重、腰围,改善2型糖尿病相关并发症。

 

       平稳降糖,津力达循证医学证据充分

      由中国科学院仝小林院士牵头完成的一项多中心、随机、双盲、安慰剂平行对照研究[3],纳入192例服用二甲双胍稳定剂量血糖控制仍不达标的2型糖尿病患者。结果显示,在二甲双胍的基础上加用津力达颗粒可进一步降低HbA1c0.92%、空腹血糖(FPG)1.34mmol/L、餐后两小时血糖(2hPG)3.0mmol/L,提高胰岛β细胞功能指数(0.36)及胰岛素敏感性,降低中医症候积分、改善症状,降低腰围。其中,降低腰围对于减缓并发症方面具有潜在治疗优势。

      仝小林院士完成的另一项纳入1810名受试者的荟萃分析[4]结果显示,与单独使用降糖西药相比,加用津力达颗粒为2型糖尿病患者群体提供了额外的益处,包括显著降低FPG、2hPG和HbA1c(0.6-0.72%),改善胰岛β细胞功能,减轻体重,并显著减少了不良事件发生率。

      此外,由中国工程院贾伟平院士牵头完成的临床研究[5]表明,津力达颗粒可显著改善血糖波动,将葡萄糖目标范围内时间(TIR)从55%提升至79%。

 

       津力达激活棕色脂肪,改善糖脂代谢

      王卫庆教授介绍,调节糖脂代谢是治疗肥胖和糖尿病的主要靶标。一项纳入52,487名受试者的人类棕色脂肪与健康关系研究[6]显示,棕色脂肪的存在与较低的2型糖尿病、血脂异常、冠状动脉疾病、脑血管疾病、充血性心力衰竭和高血压风险独立相关。

      研究表明[7-8],棕色脂肪能促进葡萄糖的摄取,改善糖代谢,促进甘油三酯清除,改善血脂,增加能量的消耗,有助于2型糖尿病患者降糖,肥胖患者减重,改善代谢综合征。因此,激活棕色脂肪功能可能成为肥胖及2型糖尿病治疗的新策略。

      系列基础研究显示,津力达颗粒可以促进棕色脂肪细胞形成,增加细胞中线粒体含量和呼吸功能,进而增加棕色脂肪组织活性。其研究主要包括以下三个方面的内容[9]

(1)津力达颗粒对高脂饮食诱导的肥胖小鼠肥胖代谢性状的影响研究发现,津力达颗粒能够明显抑制高脂饮食诱导的肥胖小鼠体重和体脂含量增加,改善高脂血症和葡萄糖代谢异常,减轻肝脏组织中的脂质沉积和炎症状态。

(2)津力达颗粒对高脂饮食诱导的肥胖小鼠棕色脂肪功能的作用研究显示,津力达颗粒能够明显上调棕色脂肪特异性产热基因UCP1、PRDM16、Dio2和ELOVL3及产热蛋白UCP1、PGC-1ɑ及OXPHOS的表达;显著增加棕色脂肪组织中线粒体的含量及脂肪酸氧化代谢功能;改善高脂饮食诱导的肥胖小鼠的多种糖脂代谢紊乱。这些特性可能是通过激活棕色脂肪组织的功能,增加产热和能量消耗而实现的。

(3)津力达颗粒对间充质干细胞向成熟棕色脂肪细胞分化及功能影响的机制研究发现,津力达颗粒能够明显促进间充质干细胞C3H10T1/2向成熟棕色脂肪细胞分化,增加棕色脂肪特异性产热相关基因及蛋白的表达,并能增加成熟棕色脂肪细胞的线粒体含量及其呼吸功能;增加棕色脂肪细胞的活性及线粒体脂肪酸氧化代谢水平。

 

总结

     作为我国中医药治疗糖尿病的代表性药物,津力达颗粒对伴有超重/肥胖、血脂异常的2型糖尿病患者有良好的治疗作用。在西药治疗的基础上加津力达颗粒,可改善胰岛β细胞功能和胰岛素抵抗,进一步降低HbA1c,减轻体重,改善症状。同时,津力达颗粒能够改善血糖波动,使血糖控制更为平稳。津力达颗粒激活棕色脂肪产热功能是发挥其作用的机制之一,这为津力达颗粒用于2型糖尿病、尤其合并血脂异常或超重/肥胖患者的治疗提供了实验依据。

     CODHy AP会议定位于糖尿病、肥胖和高血压的数字化健康创新和独特的讨论论坛,强调与流行病学、遗传学、诊断学,典型并发症和治疗特征反应的相关问题。十年间,CODHy AP受到越来越多国内外专家学者的关注和参与,也为国内临床医生提供了交流的机会和平台。

      作为大会创始人之一、Itamar Raz 教授表示,CODHy AP的特殊之处在于分享的内容都是围绕患者的切实临床问题,讨论的重点是诊疗过程中没有被解决的问题。他特别指出,今年会议首次引入了圆桌讨论,每个圆桌会议都有三至六位来自于全球的讲者。大家共同分享知识,分享不一致的观点,也分享一致的认识。Itamar Raz 教授衷心地希望,在未来的数年当中,CODHy AP能够保持和延续大会这种习惯与态度——从讨论中学习。

      可以看到,随着CODHy AP的持续开展,会议在传播、分享国际前沿学科新发展的同时,也将国内有价值的基础和临床研究内容展开国际交流,为中国内分泌领域赢得了更高的国际地位,让世界看到了更多中国成果。

 

[1] Sun H, Saeedi P, Karuranga S, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045[J]. Diabetes Res Clin Pract, 2022,183:109119.

[2] 中国2型糖尿病防治指南(2020年版)[J]. 中华糖尿病杂志, 2021,13(4):315-409.

[3] Lian F, Tian J, Chen X, et al. The Efficacy and Safety of Chinese Herbal Medicine Jinlida as Add-On Medication in Type 2 Diabetes Patients Ineffectively Managed by Metformin Monotherapy: A Double-Blind, Randomized, Placebo-Controlled, Multicenter Trial[J]. PLoS One, 2015,10(6):e130550.

[4] Lian F, Jin, Bao Q, et al. Effectiveness of traditional Chinese medicine Jinlida granules as an add-on therapy for type 2 diabetes: A system review and meta-analysis of randomized controlled trials[J]. J Diabetes, 2019,11(7):540-551.

[5] Pan J, Xu Y, Chen S, et al. The Effectiveness of Traditional Chinese Medicine Jinlida Granules on Glycemic Variability in Newly Diagnosed Type 2 Diabetes: A Double-Blinded, Randomized Trial[J]. J Diabetes Res, 2021,2021:6303063.

[6] Becher T,Palanisamy S, Kramer DJ,et al. Brown adipose tissue is associated with cardiometabolic health[J] .Nat Med, 2021, 27: 58-65..

[7] Frontini A, Cinti S. Distribution and development of brown adipocytes in the murine and human adipose  organ[J]. Cell Metab, 2010,11(4):253-256.

[8] Cypess AM, et al.Brown fat as a therapy for obesity and diabetes[J].Curr Opin Endocrinol Diabetes Obes. 2010 Apr;17(2):143-9.

[9] Zhang H,Hao YY,Wei C, et al. Chinese medicine Jinlida granules improve high-fat-diet induced metabolic disorders via activation of brown adipose tissue in mice[J] .Biomed Pharmacother, 2019, 114: 108781.

 

 

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#插入话题
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  2. [GetPortalCommentsPageByObjectIdResponse(id=1907225, encodeId=6712190e225bd, content=<a href='/topic/show?id=acc02289e40' target=_blank style='color:#2F92EE;'>#临床疗效#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22897, encryptionId=acc02289e40, topicName=临床疗效)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8346212, createdName=respect, createdTime=Fri Nov 04 06:12:04 CST 2022, time=2022-11-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1233260, encodeId=dd6312332609d, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=feaf8199841, createdName=ms3000001866002760, createdTime=Mon Jul 18 20:19:56 CST 2022, time=2022-07-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1224999, encodeId=90c412249998c, content=签到学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211111/81c0b64745c644319545ec26d7ef0b34/9ddb2864d5df4dd9bf4305e380bffc96.jpg, createdBy=c7835705079, createdName=屋顶瞄爱赏月, createdTime=Tue Jun 07 16:58:25 CST 2022, time=2022-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1254865, encodeId=23f9125486532, content=<a href='/topic/show?id=78b3e6858b7' target=_blank style='color:#2F92EE;'>#糖脂代谢#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76858, encryptionId=78b3e6858b7, topicName=糖脂代谢)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=19ad38, createdName=lq1767, createdTime=Sun Jun 05 02:12:04 CST 2022, time=2022-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1410221, encodeId=ecab141022188, content=<a href='/topic/show?id=2c1c35262a9' target=_blank style='color:#2F92EE;'>#医药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35262, encryptionId=2c1c35262a9, topicName=医药)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=36f62754598, createdName=cathymary, createdTime=Sun Jun 05 02:12:04 CST 2022, time=2022-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1597082, encodeId=a4ec159e082e8, content=<a href='/topic/show?id=e7f6842982d' target=_blank style='color:#2F92EE;'>#脂代谢#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84298, encryptionId=e7f6842982d, topicName=脂代谢)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ce3218475330, createdName=huangdf, createdTime=Sun Jun 05 02:12:04 CST 2022, time=2022-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1224266, encodeId=755912242667c, content=学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f03a5433387, createdName=ms5000000518166734, createdTime=Fri Jun 03 16:50:21 CST 2022, time=2022-06-03, status=1, ipAttribution=)]
    2022-07-18 ms3000001866002760

    学习

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1907225, encodeId=6712190e225bd, content=<a href='/topic/show?id=acc02289e40' target=_blank style='color:#2F92EE;'>#临床疗效#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22897, encryptionId=acc02289e40, topicName=临床疗效)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8346212, createdName=respect, createdTime=Fri Nov 04 06:12:04 CST 2022, time=2022-11-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1233260, encodeId=dd6312332609d, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=feaf8199841, createdName=ms3000001866002760, createdTime=Mon Jul 18 20:19:56 CST 2022, time=2022-07-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1224999, encodeId=90c412249998c, content=签到学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211111/81c0b64745c644319545ec26d7ef0b34/9ddb2864d5df4dd9bf4305e380bffc96.jpg, createdBy=c7835705079, createdName=屋顶瞄爱赏月, createdTime=Tue Jun 07 16:58:25 CST 2022, time=2022-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1254865, encodeId=23f9125486532, content=<a href='/topic/show?id=78b3e6858b7' target=_blank style='color:#2F92EE;'>#糖脂代谢#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76858, encryptionId=78b3e6858b7, topicName=糖脂代谢)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=19ad38, createdName=lq1767, createdTime=Sun Jun 05 02:12:04 CST 2022, time=2022-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1410221, encodeId=ecab141022188, content=<a href='/topic/show?id=2c1c35262a9' target=_blank style='color:#2F92EE;'>#医药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35262, encryptionId=2c1c35262a9, topicName=医药)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=36f62754598, createdName=cathymary, createdTime=Sun Jun 05 02:12:04 CST 2022, time=2022-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1597082, encodeId=a4ec159e082e8, content=<a href='/topic/show?id=e7f6842982d' target=_blank style='color:#2F92EE;'>#脂代谢#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84298, encryptionId=e7f6842982d, topicName=脂代谢)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ce3218475330, createdName=huangdf, createdTime=Sun Jun 05 02:12:04 CST 2022, time=2022-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1224266, encodeId=755912242667c, content=学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f03a5433387, createdName=ms5000000518166734, createdTime=Fri Jun 03 16:50:21 CST 2022, time=2022-06-03, status=1, ipAttribution=)]
    2022-06-07 屋顶瞄爱赏月

    签到学习

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1907225, encodeId=6712190e225bd, content=<a href='/topic/show?id=acc02289e40' target=_blank style='color:#2F92EE;'>#临床疗效#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22897, encryptionId=acc02289e40, topicName=临床疗效)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8346212, createdName=respect, createdTime=Fri Nov 04 06:12:04 CST 2022, time=2022-11-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1233260, encodeId=dd6312332609d, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=feaf8199841, createdName=ms3000001866002760, createdTime=Mon Jul 18 20:19:56 CST 2022, time=2022-07-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1224999, encodeId=90c412249998c, content=签到学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211111/81c0b64745c644319545ec26d7ef0b34/9ddb2864d5df4dd9bf4305e380bffc96.jpg, createdBy=c7835705079, createdName=屋顶瞄爱赏月, createdTime=Tue Jun 07 16:58:25 CST 2022, time=2022-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1254865, encodeId=23f9125486532, content=<a href='/topic/show?id=78b3e6858b7' target=_blank style='color:#2F92EE;'>#糖脂代谢#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76858, encryptionId=78b3e6858b7, topicName=糖脂代谢)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=19ad38, createdName=lq1767, createdTime=Sun Jun 05 02:12:04 CST 2022, time=2022-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1410221, encodeId=ecab141022188, content=<a href='/topic/show?id=2c1c35262a9' target=_blank style='color:#2F92EE;'>#医药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35262, encryptionId=2c1c35262a9, topicName=医药)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=36f62754598, createdName=cathymary, createdTime=Sun Jun 05 02:12:04 CST 2022, time=2022-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1597082, encodeId=a4ec159e082e8, content=<a href='/topic/show?id=e7f6842982d' target=_blank style='color:#2F92EE;'>#脂代谢#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84298, encryptionId=e7f6842982d, topicName=脂代谢)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ce3218475330, createdName=huangdf, createdTime=Sun Jun 05 02:12:04 CST 2022, time=2022-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1224266, encodeId=755912242667c, content=学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f03a5433387, createdName=ms5000000518166734, createdTime=Fri Jun 03 16:50:21 CST 2022, time=2022-06-03, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1907225, encodeId=6712190e225bd, content=<a href='/topic/show?id=acc02289e40' target=_blank style='color:#2F92EE;'>#临床疗效#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22897, encryptionId=acc02289e40, topicName=临床疗效)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8346212, createdName=respect, createdTime=Fri Nov 04 06:12:04 CST 2022, time=2022-11-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1233260, encodeId=dd6312332609d, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=feaf8199841, createdName=ms3000001866002760, createdTime=Mon Jul 18 20:19:56 CST 2022, time=2022-07-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1224999, encodeId=90c412249998c, content=签到学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211111/81c0b64745c644319545ec26d7ef0b34/9ddb2864d5df4dd9bf4305e380bffc96.jpg, createdBy=c7835705079, createdName=屋顶瞄爱赏月, createdTime=Tue Jun 07 16:58:25 CST 2022, time=2022-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1254865, encodeId=23f9125486532, content=<a href='/topic/show?id=78b3e6858b7' target=_blank style='color:#2F92EE;'>#糖脂代谢#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76858, encryptionId=78b3e6858b7, topicName=糖脂代谢)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=19ad38, createdName=lq1767, createdTime=Sun Jun 05 02:12:04 CST 2022, time=2022-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1410221, encodeId=ecab141022188, content=<a href='/topic/show?id=2c1c35262a9' target=_blank style='color:#2F92EE;'>#医药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35262, encryptionId=2c1c35262a9, topicName=医药)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=36f62754598, createdName=cathymary, createdTime=Sun Jun 05 02:12:04 CST 2022, time=2022-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1597082, encodeId=a4ec159e082e8, content=<a href='/topic/show?id=e7f6842982d' target=_blank style='color:#2F92EE;'>#脂代谢#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84298, encryptionId=e7f6842982d, topicName=脂代谢)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ce3218475330, createdName=huangdf, createdTime=Sun Jun 05 02:12:04 CST 2022, time=2022-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1224266, encodeId=755912242667c, content=学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f03a5433387, createdName=ms5000000518166734, createdTime=Fri Jun 03 16:50:21 CST 2022, time=2022-06-03, status=1, ipAttribution=)]
    2022-06-05 cathymary
  6. [GetPortalCommentsPageByObjectIdResponse(id=1907225, encodeId=6712190e225bd, content=<a href='/topic/show?id=acc02289e40' target=_blank style='color:#2F92EE;'>#临床疗效#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22897, encryptionId=acc02289e40, topicName=临床疗效)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8346212, createdName=respect, createdTime=Fri Nov 04 06:12:04 CST 2022, time=2022-11-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1233260, encodeId=dd6312332609d, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=feaf8199841, createdName=ms3000001866002760, createdTime=Mon Jul 18 20:19:56 CST 2022, time=2022-07-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1224999, encodeId=90c412249998c, content=签到学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211111/81c0b64745c644319545ec26d7ef0b34/9ddb2864d5df4dd9bf4305e380bffc96.jpg, createdBy=c7835705079, createdName=屋顶瞄爱赏月, createdTime=Tue Jun 07 16:58:25 CST 2022, time=2022-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1254865, encodeId=23f9125486532, content=<a href='/topic/show?id=78b3e6858b7' target=_blank style='color:#2F92EE;'>#糖脂代谢#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76858, encryptionId=78b3e6858b7, topicName=糖脂代谢)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=19ad38, createdName=lq1767, createdTime=Sun Jun 05 02:12:04 CST 2022, time=2022-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1410221, encodeId=ecab141022188, content=<a href='/topic/show?id=2c1c35262a9' target=_blank style='color:#2F92EE;'>#医药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35262, encryptionId=2c1c35262a9, topicName=医药)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=36f62754598, createdName=cathymary, createdTime=Sun Jun 05 02:12:04 CST 2022, time=2022-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1597082, encodeId=a4ec159e082e8, content=<a href='/topic/show?id=e7f6842982d' target=_blank style='color:#2F92EE;'>#脂代谢#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84298, encryptionId=e7f6842982d, topicName=脂代谢)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ce3218475330, createdName=huangdf, createdTime=Sun Jun 05 02:12:04 CST 2022, time=2022-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1224266, encodeId=755912242667c, content=学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f03a5433387, createdName=ms5000000518166734, createdTime=Fri Jun 03 16:50:21 CST 2022, time=2022-06-03, status=1, ipAttribution=)]
    2022-06-05 huangdf
  7. [GetPortalCommentsPageByObjectIdResponse(id=1907225, encodeId=6712190e225bd, content=<a href='/topic/show?id=acc02289e40' target=_blank style='color:#2F92EE;'>#临床疗效#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22897, encryptionId=acc02289e40, topicName=临床疗效)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8346212, createdName=respect, createdTime=Fri Nov 04 06:12:04 CST 2022, time=2022-11-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1233260, encodeId=dd6312332609d, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=feaf8199841, createdName=ms3000001866002760, createdTime=Mon Jul 18 20:19:56 CST 2022, time=2022-07-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1224999, encodeId=90c412249998c, content=签到学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211111/81c0b64745c644319545ec26d7ef0b34/9ddb2864d5df4dd9bf4305e380bffc96.jpg, createdBy=c7835705079, createdName=屋顶瞄爱赏月, createdTime=Tue Jun 07 16:58:25 CST 2022, time=2022-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1254865, encodeId=23f9125486532, content=<a href='/topic/show?id=78b3e6858b7' target=_blank style='color:#2F92EE;'>#糖脂代谢#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76858, encryptionId=78b3e6858b7, topicName=糖脂代谢)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=19ad38, createdName=lq1767, createdTime=Sun Jun 05 02:12:04 CST 2022, time=2022-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1410221, encodeId=ecab141022188, content=<a href='/topic/show?id=2c1c35262a9' target=_blank style='color:#2F92EE;'>#医药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35262, encryptionId=2c1c35262a9, topicName=医药)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=36f62754598, createdName=cathymary, createdTime=Sun Jun 05 02:12:04 CST 2022, time=2022-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1597082, encodeId=a4ec159e082e8, content=<a href='/topic/show?id=e7f6842982d' target=_blank style='color:#2F92EE;'>#脂代谢#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84298, encryptionId=e7f6842982d, topicName=脂代谢)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ce3218475330, createdName=huangdf, createdTime=Sun Jun 05 02:12:04 CST 2022, time=2022-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1224266, encodeId=755912242667c, content=学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f03a5433387, createdName=ms5000000518166734, createdTime=Fri Jun 03 16:50:21 CST 2022, time=2022-06-03, status=1, ipAttribution=)]
    2022-06-03 ms5000000518166734

    学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习

    0

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