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J Rheumatol：利妥昔单抗对难治性抗HMGCR免疫介导性坏死性肌病的疗效

2018-12-17 xiangting MedSci原创

坏死性肌病抗HMGCR利妥昔单抗疗效
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三分之一的难治性抗HMGCR患者在RTX治疗后肌力改善或有其他疾病活动性改善的证据。

有研究提出了抗-3-羟基-3-甲基戊二酰辅酶A还原酶（抗HMGCR）抗体的致病作用。这项研究目的是评估利妥昔单抗（RTX）对抗HMGCR免疫介导性坏死性肌病的疗效。

研究人员回顾性分析了所有接受过RTX治疗的患者，并评估其特征和疗效。

9例患者中有3例RTX治疗后肌力稳定或有改善±肌酸激酶水平下降，或磁共振成像T2/短时翻转恢复高信号降低。2例患者在RTX治疗后，停用静脉注射免疫球蛋白并将糖皮质激素减至低剂量。

三分之一的难治性抗HMGCR患者在RTX治疗后肌力改善或有其他疾病活动性改善的证据。

原始出处：

Océane Landon-Cardinal. Rituximab in the Treatment of Refractory Anti-HMGCR Immune-mediated Necrotizing Myopathy. J Rheumatol. 15 December 2018.

本文系梅斯医学(MedSci)原创编译整理，转载需授权！

 


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  1. [GetPortalCommentsPageByObjectIdResponse(id=1660455, encodeId=3773166045540, content=<a href='/topic/show?id=c0de32285a1' target=_blank style='color:#2F92EE;'>#利妥昔#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32285, encryptionId=c0de32285a1, topicName=利妥昔)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a58d25117340, createdName=花花1374, createdTime=Fri Feb 01 08:53:00 CST 2019, time=2019-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359678, encodeId=16ca3596e8e5, content=学习学习努力学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQpl0ENSJScphsFtdgfibXX1g1IuEYGCjP23UqCd52TxTpSZibtPiclyusaHicnNXd78alaia19Qy1nAFo18/0, createdBy=50381491660, createdName=zwjnj2, createdTime=Thu Jan 31 19:14:56 CST 2019, time=2019-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=356391, encodeId=e16c356391d5, content=学习学习永远学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQpl0ENSJScphsFtdgfibXX1g1IuEYGCjP23UqCd52TxTpSZibtPiclyusaHicnNXd78alaia19Qy1nAFo18/0, createdBy=50381491660, createdName=zwjnj2, createdTime=Tue Dec 25 17:20:07 CST 2018, time=2018-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1362927, encodeId=903c136292ece, content=<a href='/topic/show?id=b723414321c' target=_blank style='color:#2F92EE;'>#坏死#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=41432, encryptionId=b723414321c, topicName=坏死)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c0e3195, createdName=millore, createdTime=Wed Dec 19 06:53:00 CST 2018, time=2018-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1528533, encodeId=d9481528533aa, content=<a href='/topic/show?id=74b798601a1' target=_blank style='color:#2F92EE;'>#难治性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98601, encryptionId=74b798601a1, topicName=难治性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a1ef11916292, createdName=freve, createdTime=Wed Dec 19 06:53:00 CST 2018, time=2018-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1622366, encodeId=23011622366a6, content=<a href='/topic/show?id=b9578094833' target=_blank style='color:#2F92EE;'>#肌病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80948, encryptionId=b9578094833, topicName=肌病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Wed Dec 19 06:53:00 CST 2018, time=2018-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032006, encodeId=f80a103200600, content=谢谢梅斯提供这么好的信息，学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Mon Dec 17 18:53:00 CST 2018, time=2018-12-17, status=1, ipAttribution=)]
    2019-02-01 花花1374

    #利妥昔#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1660455, encodeId=3773166045540, content=<a href='/topic/show?id=c0de32285a1' target=_blank style='color:#2F92EE;'>#利妥昔#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32285, encryptionId=c0de32285a1, topicName=利妥昔)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a58d25117340, createdName=花花1374, createdTime=Fri Feb 01 08:53:00 CST 2019, time=2019-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359678, encodeId=16ca3596e8e5, content=学习学习努力学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQpl0ENSJScphsFtdgfibXX1g1IuEYGCjP23UqCd52TxTpSZibtPiclyusaHicnNXd78alaia19Qy1nAFo18/0, createdBy=50381491660, createdName=zwjnj2, createdTime=Thu Jan 31 19:14:56 CST 2019, time=2019-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=356391, encodeId=e16c356391d5, content=学习学习永远学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQpl0ENSJScphsFtdgfibXX1g1IuEYGCjP23UqCd52TxTpSZibtPiclyusaHicnNXd78alaia19Qy1nAFo18/0, createdBy=50381491660, createdName=zwjnj2, createdTime=Tue Dec 25 17:20:07 CST 2018, time=2018-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1362927, encodeId=903c136292ece, content=<a href='/topic/show?id=b723414321c' target=_blank style='color:#2F92EE;'>#坏死#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=41432, encryptionId=b723414321c, topicName=坏死)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c0e3195, createdName=millore, createdTime=Wed Dec 19 06:53:00 CST 2018, time=2018-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1528533, encodeId=d9481528533aa, content=<a href='/topic/show?id=74b798601a1' target=_blank style='color:#2F92EE;'>#难治性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98601, encryptionId=74b798601a1, topicName=难治性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a1ef11916292, createdName=freve, createdTime=Wed Dec 19 06:53:00 CST 2018, time=2018-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1622366, encodeId=23011622366a6, content=<a href='/topic/show?id=b9578094833' target=_blank style='color:#2F92EE;'>#肌病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80948, encryptionId=b9578094833, topicName=肌病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Wed Dec 19 06:53:00 CST 2018, time=2018-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032006, encodeId=f80a103200600, content=谢谢梅斯提供这么好的信息，学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Mon Dec 17 18:53:00 CST 2018, time=2018-12-17, status=1, ipAttribution=)]
    2019-01-31 zwjnj2

    学习学习努力学习

    0

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    2018-12-25 zwjnj2

    学习学习永远学习

    0

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    2018-12-19 millore

    #坏死#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1660455, encodeId=3773166045540, content=<a href='/topic/show?id=c0de32285a1' target=_blank style='color:#2F92EE;'>#利妥昔#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32285, encryptionId=c0de32285a1, topicName=利妥昔)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a58d25117340, createdName=花花1374, createdTime=Fri Feb 01 08:53:00 CST 2019, time=2019-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359678, encodeId=16ca3596e8e5, content=学习学习努力学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQpl0ENSJScphsFtdgfibXX1g1IuEYGCjP23UqCd52TxTpSZibtPiclyusaHicnNXd78alaia19Qy1nAFo18/0, createdBy=50381491660, createdName=zwjnj2, createdTime=Thu Jan 31 19:14:56 CST 2019, time=2019-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=356391, encodeId=e16c356391d5, content=学习学习永远学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQpl0ENSJScphsFtdgfibXX1g1IuEYGCjP23UqCd52TxTpSZibtPiclyusaHicnNXd78alaia19Qy1nAFo18/0, createdBy=50381491660, createdName=zwjnj2, createdTime=Tue Dec 25 17:20:07 CST 2018, time=2018-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1362927, encodeId=903c136292ece, content=<a href='/topic/show?id=b723414321c' target=_blank style='color:#2F92EE;'>#坏死#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=41432, encryptionId=b723414321c, topicName=坏死)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c0e3195, createdName=millore, createdTime=Wed Dec 19 06:53:00 CST 2018, time=2018-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1528533, encodeId=d9481528533aa, content=<a href='/topic/show?id=74b798601a1' target=_blank style='color:#2F92EE;'>#难治性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98601, encryptionId=74b798601a1, topicName=难治性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a1ef11916292, createdName=freve, createdTime=Wed Dec 19 06:53:00 CST 2018, time=2018-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1622366, encodeId=23011622366a6, content=<a href='/topic/show?id=b9578094833' target=_blank style='color:#2F92EE;'>#肌病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80948, encryptionId=b9578094833, topicName=肌病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Wed Dec 19 06:53:00 CST 2018, time=2018-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032006, encodeId=f80a103200600, content=谢谢梅斯提供这么好的信息，学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Mon Dec 17 18:53:00 CST 2018, time=2018-12-17, status=1, ipAttribution=)]
    2018-12-19 freve

    #难治性#

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1660455, encodeId=3773166045540, content=<a href='/topic/show?id=c0de32285a1' target=_blank style='color:#2F92EE;'>#利妥昔#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32285, encryptionId=c0de32285a1, topicName=利妥昔)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a58d25117340, createdName=花花1374, createdTime=Fri Feb 01 08:53:00 CST 2019, time=2019-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359678, encodeId=16ca3596e8e5, content=学习学习努力学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQpl0ENSJScphsFtdgfibXX1g1IuEYGCjP23UqCd52TxTpSZibtPiclyusaHicnNXd78alaia19Qy1nAFo18/0, createdBy=50381491660, createdName=zwjnj2, createdTime=Thu Jan 31 19:14:56 CST 2019, time=2019-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=356391, encodeId=e16c356391d5, content=学习学习永远学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQpl0ENSJScphsFtdgfibXX1g1IuEYGCjP23UqCd52TxTpSZibtPiclyusaHicnNXd78alaia19Qy1nAFo18/0, createdBy=50381491660, createdName=zwjnj2, createdTime=Tue Dec 25 17:20:07 CST 2018, time=2018-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1362927, encodeId=903c136292ece, content=<a href='/topic/show?id=b723414321c' target=_blank style='color:#2F92EE;'>#坏死#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=41432, encryptionId=b723414321c, topicName=坏死)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c0e3195, createdName=millore, createdTime=Wed Dec 19 06:53:00 CST 2018, time=2018-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1528533, encodeId=d9481528533aa, content=<a href='/topic/show?id=74b798601a1' target=_blank style='color:#2F92EE;'>#难治性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98601, encryptionId=74b798601a1, topicName=难治性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a1ef11916292, createdName=freve, createdTime=Wed Dec 19 06:53:00 CST 2018, time=2018-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1622366, encodeId=23011622366a6, content=<a href='/topic/show?id=b9578094833' target=_blank style='color:#2F92EE;'>#肌病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80948, encryptionId=b9578094833, topicName=肌病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Wed Dec 19 06:53:00 CST 2018, time=2018-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032006, encodeId=f80a103200600, content=谢谢梅斯提供这么好的信息，学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Mon Dec 17 18:53:00 CST 2018, time=2018-12-17, status=1, ipAttribution=)]
    2018-12-19 爆笑小医

    #肌病#

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1660455, encodeId=3773166045540, content=<a href='/topic/show?id=c0de32285a1' target=_blank style='color:#2F92EE;'>#利妥昔#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32285, encryptionId=c0de32285a1, topicName=利妥昔)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a58d25117340, createdName=花花1374, createdTime=Fri Feb 01 08:53:00 CST 2019, time=2019-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359678, encodeId=16ca3596e8e5, content=学习学习努力学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQpl0ENSJScphsFtdgfibXX1g1IuEYGCjP23UqCd52TxTpSZibtPiclyusaHicnNXd78alaia19Qy1nAFo18/0, createdBy=50381491660, createdName=zwjnj2, createdTime=Thu Jan 31 19:14:56 CST 2019, time=2019-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=356391, encodeId=e16c356391d5, content=学习学习永远学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQpl0ENSJScphsFtdgfibXX1g1IuEYGCjP23UqCd52TxTpSZibtPiclyusaHicnNXd78alaia19Qy1nAFo18/0, createdBy=50381491660, createdName=zwjnj2, createdTime=Tue Dec 25 17:20:07 CST 2018, time=2018-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1362927, encodeId=903c136292ece, content=<a href='/topic/show?id=b723414321c' target=_blank style='color:#2F92EE;'>#坏死#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=41432, encryptionId=b723414321c, topicName=坏死)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c0e3195, createdName=millore, createdTime=Wed Dec 19 06:53:00 CST 2018, time=2018-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1528533, encodeId=d9481528533aa, content=<a href='/topic/show?id=74b798601a1' target=_blank style='color:#2F92EE;'>#难治性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98601, encryptionId=74b798601a1, topicName=难治性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a1ef11916292, createdName=freve, createdTime=Wed Dec 19 06:53:00 CST 2018, time=2018-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1622366, encodeId=23011622366a6, content=<a href='/topic/show?id=b9578094833' target=_blank style='color:#2F92EE;'>#肌病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80948, encryptionId=b9578094833, topicName=肌病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Wed Dec 19 06:53:00 CST 2018, time=2018-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032006, encodeId=f80a103200600, content=谢谢梅斯提供这么好的信息，学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Mon Dec 17 18:53:00 CST 2018, time=2018-12-17, status=1, ipAttribution=)]
    2018-12-17 内科新手

    谢谢梅斯提供这么好的信息，学到很多

    0

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