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骨质疏松症基层合理用药指南,3分钟get要点!

2021-07-05 rayms 梅斯医学整理

骨质疏松症是一种以骨量低、骨组织微结构损 坏为表现,导致骨脆性增加、易发生骨折为特征的全身性代谢性骨病 。

骨质疏松症是一种以骨量低、骨组织微结构损 坏为表现,导致骨脆性增加、易发生骨折为特征的全身性代谢性骨病 。骨质疏松症可发生于任何年龄,但多见于绝经后女性和老年男性。骨质疏松 症按病因分为原发性和继发性两大类,2021年中华医学会临床药学分会发布了《骨质疏松症基层合理用药》指南,主要针对原发性骨质疏松症。

一,药物治疗原则

(一)基本骨营养补充

抗骨质疏松症的治疗应强调在充足钙与维生素D营养补充的基础上,钙和维生素D的使用应贯 穿于整个骨质疏松治疗过程,与抑制骨吸收药和促 进骨形成药合用可提高骨密度,预防骨折风险。

(二)抑制骨吸收

破骨细胞骨吸收功能异常活跃会引起骨量丢 失过多,从而导致骨折风险。抑制骨吸收药通过减 少破骨细胞的生成或减少破骨细胞活性来抑制骨 吸收,对于快速骨丢失的严重骨质疏松症患者可使 用该类药物进行治疗。

目前抑制骨吸收药主要有双磷酸盐如阿仑膦 酸钠、唑来膦酸和利塞膦酸钠,选择性雌激素受 体调节药如雷洛昔酚 ,以及降钙素如鲑降钙素和 依降钙素等,它们对预防和或治疗骨质疏松症有效。

(三)促进骨形成

骨形成和骨吸收的动态平衡维持正常骨骼结 构和骨密度。当骨形成的量或速度低于骨吸收时, 就会发生骨质疏松。特立帕肽能促进成骨祖细胞 增生分化,直接抑制成骨细胞凋亡,延长成骨作用 时间,促进衬里细胞向成骨细胞转化及刺激成骨细 胞产生 IGF‑1和转化生长因子发挥其骨合成效应, 在促进骨形成方面有明确的疗效。

(四)其他机制类

该类药物能减慢骨重建,兼具抑制骨吸收和刺 激成骨细胞生长作用,如锶盐雷奈酸锶和异黄酮 衍生物依普黄酮

(五)抗骨质疏松药物的选择

对低中度骨折风险者,如相对年轻的绝经后妇 女,骨密度水平较低但无骨折史的患者,首选口服 药物如阿仑膦酸钠治疗。对口服不能耐受、依从性 欠佳及高骨折风险者,如多发椎体骨折或髋部骨折的老年患者、骨密度水平极低的患者,可考虑使用 注射剂如唑来膦酸、特立帕肽治疗。对于仅存在椎 体骨折高风险,而髋部和非椎体骨折风险不高的患 者,可考虑选用雌激素或选择性雌激素受体调节药 如雷洛昔芬治疗。新发骨折伴疼痛的患者,可考虑 短期使用降钙素治疗。

(六)抗骨质疏松药物的疗程

抗骨质疏松症药物疗程应个体化,所有治疗应 至少持续1年,建议静脉双膦酸盐治疗3年,口服双 膦酸盐治疗 5 年,疗程结束后对骨折风险进行评 估,如为低风险,可考虑实施药物假期;如骨折风险 仍高,可以继续使用双膦酸盐或换用其他抗骨质疏 松症药物。特立帕肽疗程为18~24个月,降钙素 连续使用时间一般不超过3个月。

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二,治疗药物

(一)阿法骨化醇

1,药品分类:骨营养补充药。

2,用药目的:用于提高骨密度。

3,禁忌证:禁用于对维生素 D 及其类似物过 敏、高钙血症、有维生素D中毒征象者。

4,不良反应及处理:小剂量单独使用(<1.0 μg/d 一般无不良反应,长期大剂量用药或与钙剂合用可 能会引起高钙血症和高钙尿症,建议定期检查患者 血钙和尿钙水平。

5,药物相互作用:与钙剂合用可能会引起血钙 升高;与大剂量磷剂合用可诱发高磷血症;与噻嗪 类利尿剂合用有发生高钙血症的危险;与洋地黄毒 苷类药物合用若出现高钙血症易诱发心律失常;与巴比妥类药物合用可加速活性维生素 D 代谢物在 肝内代谢,降低本品药效;与考来烯胺或含铝抗酸 药合用可减少本药吸收。

(二)碳酸钙(或碳酸钙+维生素D3

1,药品分类:骨营养补充药。

2,用药目的:用于治疗钙缺乏症。

3,禁忌证:禁用于高钙血症、高钙尿症、含钙肾 结石或肾结石病史患者。

4,不良反应及处理:常见的不良反应有嗳气和 便秘,一般无需停药。

5,药物相互作用:与洋地黄毒苷类药物合用可 能出现高钙血症,易诱发心律失常;大量饮用含酒 精和咖啡因的饮料以及大量吸烟会抑制钙的吸收; 大量进食富含纤维素的食物会抑制钙的吸收;与四 环素和喹诺酮类抗菌药物合用可减少它们的吸收; 与维生素D、避孕药、雌激素合用能增加钙的吸收; 与含铝的抗酸药合用会使铝的吸收增多;与噻嗪类 利尿药合用时易发生高钙血症。

(三)骨化三醇

1 药品分类:骨营养补充药。

2,用药目的:用于提高骨密度。

3 禁忌证:禁用于对维生素 D 及其类似物过 敏、与高血钙有关的疾病、有维生素D中毒征象者。

4,不良反应及处理:不良反应发生率低(< 0.001 %),长期大剂量用药可能会引起高血钙综合 征或钙中毒,建议定期检查患者血钙或尿钙水平。 偶见的急性症状包括食欲减退、头痛、呕吐、腹痛和便秘,一般不需要停止治疗。

5,药物相互作用:与噻嗪类利尿剂合用会增加 高钙血症的危险;与洋地黄毒苷类药物合用可能出 现高钙血症,易诱发心律失常;与含镁药物(如抗酸 药)合用可能导致高镁血症;与大剂量磷剂合用可 诱发高磷血症;激素可能拮抗骨化三醇对钙的促吸 收作用;胆汁酸螯合剂(包括消胆胺和司维拉姆)可 能减少骨化三醇在肠道的吸收。

(四)阿仑膦酸钠

1,药品分类:抑制骨吸收药。

2,用药目的:用于预防骨质疏松症引起的骨折。

3,禁忌证:禁用于有食管动力障碍如食管迟缓 不能、食管狭窄者,30 min 内难以坚持站立或端坐 位者,对本品任何成分过敏者。

4,不良反应及处理:耐受性良好,少数患者可 见腹痛、腹泻、恶心、便秘、消化不良等,不良反应通 常轻微,一般不需要停止治疗。

5,药物相互作用:与抗酸药物或导泻剂合用会 影响阿仑膦酸钠吸收;与氨基糖苷类合用会诱发低 钙血症。

(五)唑来膦酸

1,药品分类:抑制骨吸收药。

2,用药目的:用于预防骨质疏松症引起的骨折。

3,禁忌证:禁用于对唑来膦酸或其他双膦酸盐 过敏者,严重肾功能不全患者,妊娠期和哺乳期 妇女。

4,不良反应及处理:最常见的不良反应为发 热,其他常见的有流感样症状如寒战、疲劳、无力和疼痛,骨骼肌肉疼痛如肌痛、关节痛、骨痛和背痛, 但其不良反应多为轻度和一过性的,多数情况下无 需特殊处理,会在 24~48 h内自动消退。

5,药物相互作用:与显著影响肾功能的药物如 氨基糖苷类或利尿剂合用可能会诱发低钙血症。

(六)利塞膦酸钠

1,药品分类:抑制骨吸收药。

2,用药目的:用于治疗和预防绝经后妇女的骨 质疏松症。

3,禁忌证:禁用于对利塞膦酸过敏者,低钙血 症患者,30 min 内难以坚持站立或端坐位者,哺乳 期妇女。

4,不良反应及处理:常见不良反应有消化系统 不良反应如吞咽困难、食道炎、食道或胃溃疡和流 感样综合征如头痛、头晕、皮疹、关节痛等。

5,药物相互作用:与钙剂、抗酸剂以及含二价 阳离子的口服制剂同服会影响吸收。

(七)雷洛昔芬

1,药品分类:抑制骨吸收药。

2,用药目的:用于治疗和预防绝经后妇女的骨 质疏松症。

3,禁忌证:禁用于妊娠期妇女,静脉血栓栓塞 性疾病者(包括深静脉血栓、肺栓塞和视网膜静脉 血栓者),对雷洛昔芬或片剂中所含的任何赋形剂 成分过敏者,肝功能减退包括胆汁瘀积,严重肾功能减退者,难以解释的子宫出血者,有子宫内膜癌 症状和体征者。

4,不良反应及处理:常见不良反应有潮热出 汗、腿部痉挛,绝大多数不良反应无需停止治疗;严 重不良反应有深静脉血栓形成、静脉血栓栓塞、脑 血管意外、肺栓塞。

5,药物相互作用:与消胆胺(或其他阴离子交 换树脂)同时服用可显著减低雷洛昔芬的吸收和肠 肝循环;雷洛昔芬可轻度增加激素结合球蛋白的浓度。

(八)鲑降钙素

1,药品分类:抑制骨吸收药。

2,用药目的:用于降低破骨细胞活性和数目, 直接抑制骨吸收,减慢骨转换。

3,禁忌证:禁用于对鲑降钙素或者本制品任何 成分敏感者。

4,不良反应及处理:可出现恶心、呕吐、头晕、 轻度的面部潮红伴发热感,这些反应常常自发性消 退,仅在极少数患者需暂时性减少剂量。

5,药物相互作用:降钙素与锂合用可能导致血 浆中锂浓度下降。

(九)依降钙素

1 药品分类:抑制骨吸收药。

2,用药目的:用于治疗骨质疏松症及骨质疏松 引起的疼痛。

3,禁忌证:禁用于对依降钙素成分有过敏史的 患者。

4,不良反应及处理:参考鲑降钙素。

5,药物相互作用:与二膦酸盐类骨吸收抑制剂 合用可能出现低钙血症。

(十)特立帕肽

1,药品分类:促进骨形成药。

2,用药目的:用于降低骨折高发风险的绝经后 妇女椎骨和非椎骨骨折风险。

3,禁忌证:禁用于对特立帕肽或其任何赋形剂 过敏者,妊娠及哺乳期妇女,高钙血症患者,严重肾 功能不全患者,除原发性骨质疏松和糖皮质激素诱 导的骨质疏松以外的其他骨骼代谢疾病(包括甲状 旁腺功能亢进和Paget病),不明原因的碱性磷酸酶 升高者,之前接受过外照射或骨骼植入放射性治疗 的患者。

4,不良反应:最常见的不良反应有恶心、肢体 疼痛、头痛和头晕。

5,药物相互作用:特立帕肽能瞬时提高血钙水 平,高血钙可能导致患者洋地黄中毒,因此使用洋 地黄的患者应慎用特立帕肽。

(十一)雷奈酸锶

1,药品分类:抑制骨吸收和促进骨形成双重作用药物。

2,用药目的:用于治疗绝经后骨质疏松症以降 低椎体和髋部骨折的危险性。

3,禁忌证:禁用于对本药成分和任何赋形剂成 分过敏者。

4,不良反应及处理:常见不良事件有恶心和腹 泻,通常程度轻微并且短暂;严重不良反应如静脉 血栓,严重的超敏反应综合征,特别是伴有嗜酸粒 细胞增多和全身症状的药物疹,需要停止使用雷奈 酸锶并开始皮质激素治疗,通常结果良好。

5,药物相互作用:食物、牛奶和牛奶制品,以及 含有钙的药品降低雷奈酸锶生物利用度 60%~ 70%,需间隔2 h服用;氢氧化铝和氢氧化镁在服用 雷奈酸锶之前 2 h服用或同时服用,雷奈酸锶的吸 收稍有降低;与四环素和喹诺酮类抗菌药物合用可 减少它们的吸收。

(十二)依普黄酮

1,药品分类:抑制骨吸收和促进骨形成双重作 用药物。

2,用药目的:用于改善骨质疏松症的骨量 减少。

3,禁忌证:禁用于对依普黄酮过敏者,低钙血 症患者。 4. 不良反应:常见的不良反应有胃纳减退、恶 心、呕吐、腹痛、腹胀。

4,不良反应:常见的不良反应有胃纳减退、恶 心、呕吐、腹痛、腹胀。

5,药物相互作用:与雌激素、茶碱和香豆素类 抗凝剂合用时,会增强它们的作用,应慎用。

原始出处

中华医学会 中华医学会临床药学分会 中华医学会杂志社 中华医学会全科医学分会 中华医学会《中华全科医师杂志》编辑委员会 基层医疗卫生机构合理用药指南编写专家组.骨质疏松症基层合理用药指南.中华全科医师杂志 2021 5 月第 20 卷第 5 Chin J Gen Pract, May 2021, Vol. 20, No. 5

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1187447, encodeId=0076118e44727, content=已学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=986b6157303, createdName=筱筱烟雨, createdTime=Sun Jan 23 12:47:46 CST 2022, time=2022-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=999862, encodeId=182b9998626e, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=127c5549124, createdName=Jason88, createdTime=Thu Jul 15 22:16:11 CST 2021, time=2021-07-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=997304, encodeId=ddbf99e30458, content=学习下, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1f221859736, createdName=ms2658711348342440, createdTime=Wed Jul 07 20:57:00 CST 2021, time=2021-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=997229, encodeId=e00199e229b3, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bdfd5541856, createdName=ms7000001076830824, createdTime=Wed Jul 07 16:13:18 CST 2021, time=2021-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1337342, encodeId=7481133e34253, content=<a href='/topic/show?id=a2c038861a1' target=_blank style='color:#2F92EE;'>#合理用药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=125, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38861, encryptionId=a2c038861a1, topicName=合理用药)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIpeueeYB1kem1yfEZrSYKBdZBoqac9USf0RxIgRICBIyDn4licyiaiakNnobeCDVpvwqaWgwTNeLRHA/132, createdBy=bb5e2500127, createdName=小几洁, createdTime=Wed Jul 07 02:35:37 CST 2021, time=2021-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1592665, encodeId=9cea159266502, content=<a href='/topic/show?id=6dc2101853ed' target=_blank style='color:#2F92EE;'>#骨质#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101853, encryptionId=6dc2101853ed, topicName=骨质)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e1d018108513, createdName=Eleven17, createdTime=Wed Jul 07 02:35:37 CST 2021, time=2021-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=996640, encodeId=8c0f99664049, content=厉害了。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2b1b5542331, createdName=白日昭只, createdTime=Tue Jul 06 00:13:05 CST 2021, time=2021-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=996429, encodeId=825899642919, content=学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30c82496029, createdName=1248b370m54暂无昵称, createdTime=Mon Jul 05 14:57:11 CST 2021, time=2021-07-05, status=1, ipAttribution=)]
    2022-01-23 筱筱烟雨

    已学习

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1187447, encodeId=0076118e44727, content=已学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=986b6157303, createdName=筱筱烟雨, createdTime=Sun Jan 23 12:47:46 CST 2022, time=2022-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=999862, encodeId=182b9998626e, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=127c5549124, createdName=Jason88, createdTime=Thu Jul 15 22:16:11 CST 2021, time=2021-07-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=997304, encodeId=ddbf99e30458, content=学习下, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1f221859736, createdName=ms2658711348342440, createdTime=Wed Jul 07 20:57:00 CST 2021, time=2021-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=997229, encodeId=e00199e229b3, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bdfd5541856, createdName=ms7000001076830824, createdTime=Wed Jul 07 16:13:18 CST 2021, time=2021-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1337342, encodeId=7481133e34253, content=<a href='/topic/show?id=a2c038861a1' target=_blank style='color:#2F92EE;'>#合理用药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=125, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38861, encryptionId=a2c038861a1, topicName=合理用药)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIpeueeYB1kem1yfEZrSYKBdZBoqac9USf0RxIgRICBIyDn4licyiaiakNnobeCDVpvwqaWgwTNeLRHA/132, createdBy=bb5e2500127, createdName=小几洁, createdTime=Wed Jul 07 02:35:37 CST 2021, time=2021-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1592665, encodeId=9cea159266502, content=<a href='/topic/show?id=6dc2101853ed' target=_blank style='color:#2F92EE;'>#骨质#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101853, encryptionId=6dc2101853ed, topicName=骨质)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e1d018108513, createdName=Eleven17, createdTime=Wed Jul 07 02:35:37 CST 2021, time=2021-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=996640, encodeId=8c0f99664049, content=厉害了。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2b1b5542331, createdName=白日昭只, createdTime=Tue Jul 06 00:13:05 CST 2021, time=2021-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=996429, encodeId=825899642919, content=学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30c82496029, createdName=1248b370m54暂无昵称, createdTime=Mon Jul 05 14:57:11 CST 2021, time=2021-07-05, status=1, ipAttribution=)]
    2021-07-15 Jason88

    学习了

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1187447, encodeId=0076118e44727, content=已学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=986b6157303, createdName=筱筱烟雨, createdTime=Sun Jan 23 12:47:46 CST 2022, time=2022-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=999862, encodeId=182b9998626e, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=127c5549124, createdName=Jason88, createdTime=Thu Jul 15 22:16:11 CST 2021, time=2021-07-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=997304, encodeId=ddbf99e30458, content=学习下, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1f221859736, createdName=ms2658711348342440, createdTime=Wed Jul 07 20:57:00 CST 2021, time=2021-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=997229, encodeId=e00199e229b3, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bdfd5541856, createdName=ms7000001076830824, createdTime=Wed Jul 07 16:13:18 CST 2021, time=2021-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1337342, encodeId=7481133e34253, content=<a href='/topic/show?id=a2c038861a1' target=_blank style='color:#2F92EE;'>#合理用药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=125, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38861, encryptionId=a2c038861a1, topicName=合理用药)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIpeueeYB1kem1yfEZrSYKBdZBoqac9USf0RxIgRICBIyDn4licyiaiakNnobeCDVpvwqaWgwTNeLRHA/132, createdBy=bb5e2500127, createdName=小几洁, createdTime=Wed Jul 07 02:35:37 CST 2021, time=2021-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1592665, encodeId=9cea159266502, content=<a href='/topic/show?id=6dc2101853ed' target=_blank style='color:#2F92EE;'>#骨质#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101853, encryptionId=6dc2101853ed, topicName=骨质)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e1d018108513, createdName=Eleven17, createdTime=Wed Jul 07 02:35:37 CST 2021, time=2021-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=996640, encodeId=8c0f99664049, content=厉害了。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2b1b5542331, createdName=白日昭只, createdTime=Tue Jul 06 00:13:05 CST 2021, time=2021-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=996429, encodeId=825899642919, content=学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30c82496029, createdName=1248b370m54暂无昵称, createdTime=Mon Jul 05 14:57:11 CST 2021, time=2021-07-05, status=1, ipAttribution=)]
    2021-07-07 ms2658711348342440

    学习下

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1187447, encodeId=0076118e44727, content=已学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=986b6157303, createdName=筱筱烟雨, createdTime=Sun Jan 23 12:47:46 CST 2022, time=2022-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=999862, encodeId=182b9998626e, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=127c5549124, createdName=Jason88, createdTime=Thu Jul 15 22:16:11 CST 2021, time=2021-07-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=997304, encodeId=ddbf99e30458, content=学习下, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1f221859736, createdName=ms2658711348342440, createdTime=Wed Jul 07 20:57:00 CST 2021, time=2021-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=997229, encodeId=e00199e229b3, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bdfd5541856, createdName=ms7000001076830824, createdTime=Wed Jul 07 16:13:18 CST 2021, time=2021-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1337342, encodeId=7481133e34253, content=<a href='/topic/show?id=a2c038861a1' target=_blank style='color:#2F92EE;'>#合理用药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=125, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38861, encryptionId=a2c038861a1, topicName=合理用药)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIpeueeYB1kem1yfEZrSYKBdZBoqac9USf0RxIgRICBIyDn4licyiaiakNnobeCDVpvwqaWgwTNeLRHA/132, createdBy=bb5e2500127, createdName=小几洁, createdTime=Wed Jul 07 02:35:37 CST 2021, time=2021-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1592665, encodeId=9cea159266502, content=<a href='/topic/show?id=6dc2101853ed' target=_blank style='color:#2F92EE;'>#骨质#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101853, encryptionId=6dc2101853ed, topicName=骨质)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e1d018108513, createdName=Eleven17, createdTime=Wed Jul 07 02:35:37 CST 2021, time=2021-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=996640, encodeId=8c0f99664049, content=厉害了。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2b1b5542331, createdName=白日昭只, createdTime=Tue Jul 06 00:13:05 CST 2021, time=2021-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=996429, encodeId=825899642919, content=学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30c82496029, createdName=1248b370m54暂无昵称, createdTime=Mon Jul 05 14:57:11 CST 2021, time=2021-07-05, status=1, ipAttribution=)]
    2021-07-07 ms7000001076830824

    学习

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1187447, encodeId=0076118e44727, content=已学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=986b6157303, createdName=筱筱烟雨, createdTime=Sun Jan 23 12:47:46 CST 2022, time=2022-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=999862, encodeId=182b9998626e, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=127c5549124, createdName=Jason88, createdTime=Thu Jul 15 22:16:11 CST 2021, time=2021-07-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=997304, encodeId=ddbf99e30458, content=学习下, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1f221859736, createdName=ms2658711348342440, createdTime=Wed Jul 07 20:57:00 CST 2021, time=2021-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=997229, encodeId=e00199e229b3, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bdfd5541856, createdName=ms7000001076830824, createdTime=Wed Jul 07 16:13:18 CST 2021, time=2021-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1337342, encodeId=7481133e34253, content=<a href='/topic/show?id=a2c038861a1' target=_blank style='color:#2F92EE;'>#合理用药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=125, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38861, encryptionId=a2c038861a1, topicName=合理用药)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIpeueeYB1kem1yfEZrSYKBdZBoqac9USf0RxIgRICBIyDn4licyiaiakNnobeCDVpvwqaWgwTNeLRHA/132, createdBy=bb5e2500127, createdName=小几洁, createdTime=Wed Jul 07 02:35:37 CST 2021, time=2021-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1592665, encodeId=9cea159266502, content=<a href='/topic/show?id=6dc2101853ed' target=_blank style='color:#2F92EE;'>#骨质#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101853, encryptionId=6dc2101853ed, topicName=骨质)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e1d018108513, createdName=Eleven17, createdTime=Wed Jul 07 02:35:37 CST 2021, time=2021-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=996640, encodeId=8c0f99664049, content=厉害了。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2b1b5542331, createdName=白日昭只, createdTime=Tue Jul 06 00:13:05 CST 2021, time=2021-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=996429, encodeId=825899642919, content=学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30c82496029, createdName=1248b370m54暂无昵称, createdTime=Mon Jul 05 14:57:11 CST 2021, time=2021-07-05, status=1, ipAttribution=)]
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    2021-07-07 Eleven17
  7. [GetPortalCommentsPageByObjectIdResponse(id=1187447, encodeId=0076118e44727, content=已学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=986b6157303, createdName=筱筱烟雨, createdTime=Sun Jan 23 12:47:46 CST 2022, time=2022-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=999862, encodeId=182b9998626e, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=127c5549124, createdName=Jason88, createdTime=Thu Jul 15 22:16:11 CST 2021, time=2021-07-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=997304, encodeId=ddbf99e30458, content=学习下, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1f221859736, createdName=ms2658711348342440, createdTime=Wed Jul 07 20:57:00 CST 2021, time=2021-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=997229, encodeId=e00199e229b3, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bdfd5541856, createdName=ms7000001076830824, createdTime=Wed Jul 07 16:13:18 CST 2021, time=2021-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1337342, encodeId=7481133e34253, content=<a href='/topic/show?id=a2c038861a1' target=_blank style='color:#2F92EE;'>#合理用药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=125, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38861, encryptionId=a2c038861a1, topicName=合理用药)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIpeueeYB1kem1yfEZrSYKBdZBoqac9USf0RxIgRICBIyDn4licyiaiakNnobeCDVpvwqaWgwTNeLRHA/132, createdBy=bb5e2500127, createdName=小几洁, createdTime=Wed Jul 07 02:35:37 CST 2021, time=2021-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1592665, encodeId=9cea159266502, content=<a href='/topic/show?id=6dc2101853ed' target=_blank style='color:#2F92EE;'>#骨质#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101853, encryptionId=6dc2101853ed, topicName=骨质)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e1d018108513, createdName=Eleven17, createdTime=Wed Jul 07 02:35:37 CST 2021, time=2021-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=996640, encodeId=8c0f99664049, content=厉害了。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2b1b5542331, createdName=白日昭只, createdTime=Tue Jul 06 00:13:05 CST 2021, time=2021-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=996429, encodeId=825899642919, content=学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30c82496029, createdName=1248b370m54暂无昵称, createdTime=Mon Jul 05 14:57:11 CST 2021, time=2021-07-05, status=1, ipAttribution=)]
    2021-07-06 白日昭只

    厉害了。。。

    0

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    2021-07-05 1248b370m54暂无昵称

    学习了。

    0

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