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盘点:一脸懵逼!到底该不该强化降压?

2016-09-04 MedSci MedSci原创

自强化降压提出以来,大部分研究证据表明早期强化降压治疗是安全和合理的。早期强化降压患者预后功能恢复更好,且有不良事件发生率降低的有利趋势。但是关于强化降压治疗的益处的争议一直不断,此外,关于最佳血压目标的随机试验数据也存在矛盾之处,对于特殊亚群早期强化降压的试验证据也并不充分,强化降压会不会带来器官灌注的减少,从而加重某些器官病变或加速病变的进程,如老年性痴呆,肾功能损害等。下一步需要更全面的,严

自强化降压提出以来,大部分研究证据表明早期强化降压治疗是安全和合理的。早期强化降压患者预后功能恢复更好,且有不良事件发生率降低的有利趋势。但是关于强化降压治疗的益处的争议一直不断,此外,关于最佳血压目标的随机试验数据也存在矛盾之处,对于特殊亚群早期强化降压的试验证据也并不充分,强化降压会不会带来器官灌注的减少,从而加重某些器官病变或加速病变的进程,如老年性痴呆,肾功能损害等。下一步需要更全面的,严谨的证据进行论证。这里小M整理了2016年以来关于强化降压的研究与大家分享。

【1】 ESC 2016:强化降压不能过头!舒张压<60 mmHg易新发冠心病和死亡(ARIC研究)

2016年8月30日在ESC 2016年会上发表的一项研究显示,低舒张压与亚临床心肌损伤和冠心病事件具有相关性,并且在脉压升高者中尤为显著。当调整治疗使舒张压<140 mmHg时,可能须审慎确保舒张压不低于70 mmHg,尤其不应低于60 mmHg。
此项研究从ARIC研究中纳入11565例成人受试者,并评估了舒张压与高敏心肌肌钙蛋白T(hs-cTnT)的相关性,以及舒张压与冠心病、卒中或死亡事件的前瞻相关性。受试者平均基线年龄为57岁,女性占57%。

结果显示,与基线舒张压为80~89 mmHg的受试者相比,舒张压<60 mmHg和60~69 mmHg受试者基线时hs-cTnT≥14 ng/L的校正比值比分别为2.2和1.5。基线时低舒张压与基于6年期间hs-cTnT估计年度变化的进展性心肌损伤具有独立相关性。与舒张压为60~69 mmHg相比,舒张压<60 mmHg与新发冠心病和死亡具有相关性,但与卒中无关。舒张压和新发冠心病与基线hs-cTnT≥14 ng/L具有最显著相关性(交互作用P值<0.001)。在基线收缩压≥120 mmHg的受试者中,低舒张压与hs-cTnT升高和新发冠心病的相关性最为显著。(文章详见——ESC 2016:强化降压不能过头!舒张压<60 mmHg易新发冠心病和死亡(ARIC研究)



【2】 脑出血患者,早期强化降压治疗可减少抗栓治疗所致血肿增加

抗血栓药物增加脑出血(ICH)和相关不良后果的发生。研究者在急性脑出血早期降血压试验中(INTERACT 1和2),确定有/无急性抗栓相关ICH患者,早期降低血压(BP)的不同作用。结果表明,脑出血患者,抗栓治疗与血肿增长增加相关,早期强化降压治疗可减少血肿的增长。

INTERACT研究中,脑出血患者(<6h)和升高的收缩压(SBP,150-180 mm Hg)随机分配到强化(目标收缩压<140 mm Hg  )或基于指南 BP管理(收缩压<180 mm Hg)进行降压。

结果共对3184例患者进行了分析。抗血栓相关的脑出血(364例,11%)不与死亡或残疾风险增加相关。降低血压治疗对死亡或残疾的影响没有异质性。24 h 后,对1309例患者行CT检查,与无抗栓治疗的患者相比(2.2/0.9 ml),抗凝治疗者血肿±IVH的体积绝对值增加较大(5.2 / 5 ml)。与未进行抗栓治疗者相比(1.3 / 1.4 ml),抗血栓治疗患者强化降压治疗减少血肿±IVH的增加4.7 / 7.1ml,两者之间没有统计学差异。(文章详见——J Neurol Neurosurg Psychiatry: 脑出血患者,早期强化降压治疗可减少抗栓治疗所致血肿增加


【3】强化降压不仅可以挽救生命,还可节省治疗成本

公布于美国高血压学会年会(ASH 2016)的研究发现,在现有高血压治疗指南中加入强化治疗策略不仅能够挽救生命,还可以节省治疗成本。相关发言人表示,这些发现与SPRINT试验的证据不谋而合,支持对心血管病高危患者进行强化治疗以更多的减少心血管病事件和死亡率。

来自哥伦比亚大学医学中心的Nathalie Moise表示,高血压治疗是廉价且有效的,医生不应该因过于担心治疗副作用而放弃对75岁以下高危患者进行强化治疗。研究者使用计算机模型模拟了向JNC7与JNC8指南中加入SPRINT血压目标能否为35~74岁患者带来更多获益的过程。

结果显示,向JNC8推荐中加入强化治疗策略能够预防43000起心血管病事件/年与15000起心血管病死亡/年。而且,如果将SPRINT目标值加入JNC7指南,每年能够减少35000起心血管病事件与14000起心血管病死亡。结果还显示,向JNC7中加入强化降压策略会增加男性治疗的效益成本,而向JNC8中加入强化治疗策略可增加女性治疗的成本效益。(文章详见——ASH 2016:强化降压治疗或为一举两得


【4】急性脑出血者强化降压无获益,且增加不良事件

ATACH-Ⅱ研究结果6月8日在线发表于NEJM,显示在急性出血性脑卒中患者的急诊治疗中,强化降压的效果不优于标准降压,校正混杂因素后两组主要终点发生率无差异。

研究纳入的患者出血体量<60 cm3,GCS评分≥5分,基线血压200.6±27.0 mmHg,平均年龄61.9岁,56.2%为亚洲人。主要终点为随机化后3个月发生死亡或残疾。在纳入1000例脑内出血患者(每组500例)的预设中期分析显示无意义后,入组即停止。

分析结果显示,强化降压组与标准降压组相比,随机化后72小时的治疗相关严重不良事件发生率无差异;随机化后7天,强化降压组肾脏严重不良事件发生率显著高于标准降压组;随机化后3个月的所有严重不良事件发生率,强化降压组亦高于标准降压组。

值得注意的是,在ATACH-Ⅱ研究中,虽然两组间随机化后72小时的治疗相关严重不良事件发生率无差异,但是强化降压组7天后的肾脏严重不良事件发生率明显增高,3个月的所有严重不良事件发生率也高于标准降压组。因此,在急性期强化降压效果不优于标准降压的背景下,应更加关注强化降压过程中发生的临床不良事件。(文章详见——NEJM:对于急性脑出血,强化降压无获益,且增加不良事件

【5】对于脑血管疾病患者,强化降压会导致肾功能衰退

目前,在脑血管疾病的患者中,强化降压对肾功能和估计肾小球滤过率(eGFR)的影响是未知的。在2610名随机降压患者中,目标分别为较低收缩压(<130mmHg)vs.较高收缩压(130-149mmHg),血肌酐被重复测量。

参与者平均年龄为63±11岁;949例(36%)患有糖尿病,平均的eGFR为80±19ml/min/1.73m2。在9个月时,在较高的和较低的BP组SBP分别137±15mmHg、127±14mmHg,差异在整个随访过程(平均3.2年)中一直保持。与较高的BP相比,较低的BP目标的eGFR下降要快-0.50 ml/min/1.73m2。差异在第一年时尤为明显,而eGFR的下降率在1年后没有差异。在BP较低的组共有313(24%)人有快速的肾功能衰退,在较高的BP组有247人(19%)。迅速下降的差异,在治疗组中在第一年很明显,但在1年后差异不显著。在随机分配到较高的BP目标的人中,充分调整之后,迅速下降与中风、MVE和复合终点的高风险相关。

在腔隙性卒中既往史且相对保存肾功能的患者中,强化降压治疗会导致快速肾功能衰退的可能性将非常大。差异主要在抗高血压治疗的第一年中能够观察到。快速肾功能衰退与正在进行强化降低血压患者的临床事件风险增加无关。(文章详见——Circulation:对于脑血管疾病患者,强化降压会导致肾功能衰退(附评论)



最后小M贴心附上强化降压与标准降压对比图



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createdName=忠诚向上, createdTime=Mon Sep 05 06:54:00 CST 2016, time=2016-09-05, status=1, ipAttribution=)]
    2016-09-08 李东泽

    要学习不断补充,才不会懵逼的意思

    0

  2. 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likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=01bb1684217, createdName=医张生, createdTime=Mon Sep 05 08:54:00 CST 2016, time=2016-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=111113, encodeId=6a2711111356, content=强化减压, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=a37a1710612, createdName=oo902, createdTime=Mon Sep 05 07:08:00 CST 2016, time=2016-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=111108, encodeId=7f6411110806, content=好好学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Mon Sep 05 06:54:00 CST 2016, time=2016-09-05, status=1, ipAttribution=)]
    2016-09-06 1771ae4158m

    学习了,好

    0

  3. 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  4. 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createdName=忠诚向上, createdTime=Mon Sep 05 06:54:00 CST 2016, time=2016-09-05, status=1, ipAttribution=)]
  5. 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createdName=忠诚向上, createdTime=Mon Sep 05 06:54:00 CST 2016, time=2016-09-05, status=1, ipAttribution=)]
    2016-09-05 李东泽

    很好,不错,以后会多学习

    0

  6. 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attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f14236, createdName=经常头晕, createdTime=Tue Sep 06 04:51:00 CST 2016, time=2016-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=111206, encodeId=b775111206bf, content=很好,不错,以后会多学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Mon Sep 05 10:04:00 CST 2016, time=2016-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=111178, encodeId=46781111e8d9, content=谢谢分享,,,,, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Mon Sep 05 09:25:00 CST 2016, time=2016-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=111177, encodeId=b4d61111e795, content=学习啦,,,,, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Mon Sep 05 09:25:00 CST 2016, time=2016-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=111153, encodeId=af0d111153fa, content=就是不能强化降压。但是有个底线, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=01bb1684217, createdName=医张生, createdTime=Mon Sep 05 08:54:00 CST 2016, time=2016-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=111113, encodeId=6a2711111356, content=强化减压, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=a37a1710612, createdName=oo902, createdTime=Mon Sep 05 07:08:00 CST 2016, time=2016-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=111108, encodeId=7f6411110806, content=好好学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Mon Sep 05 06:54:00 CST 2016, time=2016-09-05, status=1, ipAttribution=)]
    2016-09-05 医路开来

    谢谢分享,,,,

    0

  7. 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authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Mon Sep 05 09:25:00 CST 2016, time=2016-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=111177, encodeId=b4d61111e795, content=学习啦,,,,, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Mon Sep 05 09:25:00 CST 2016, time=2016-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=111153, encodeId=af0d111153fa, content=就是不能强化降压。但是有个底线, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=01bb1684217, createdName=医张生, createdTime=Mon Sep 05 08:54:00 CST 2016, time=2016-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=111113, encodeId=6a2711111356, content=强化减压, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=a37a1710612, createdName=oo902, createdTime=Mon Sep 05 07:08:00 CST 2016, time=2016-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=111108, encodeId=7f6411110806, content=好好学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Mon Sep 05 06:54:00 CST 2016, time=2016-09-05, status=1, ipAttribution=)]
    2016-09-05 医路开来

    学习啦,,,,

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=113597, encodeId=0fe611359e7a, content=要学习不断补充,才不会懵逼的意思, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Thu Sep 08 10:36:00 CST 2016, time=2016-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=111991, encodeId=b0ec11199198, content=学习了,好, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Tue Sep 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attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f14236, createdName=经常头晕, createdTime=Tue Sep 06 04:51:00 CST 2016, time=2016-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=111206, encodeId=b775111206bf, content=很好,不错,以后会多学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Mon Sep 05 10:04:00 CST 2016, time=2016-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=111178, encodeId=46781111e8d9, content=谢谢分享,,,,, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Mon Sep 05 09:25:00 CST 2016, time=2016-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=111177, encodeId=b4d61111e795, content=学习啦,,,,, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Mon Sep 05 09:25:00 CST 2016, time=2016-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=111153, encodeId=af0d111153fa, content=就是不能强化降压。但是有个底线, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=01bb1684217, createdName=医张生, createdTime=Mon Sep 05 08:54:00 CST 2016, time=2016-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=111113, encodeId=6a2711111356, content=强化减压, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=a37a1710612, createdName=oo902, createdTime=Mon Sep 05 07:08:00 CST 2016, time=2016-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=111108, encodeId=7f6411110806, content=好好学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Mon Sep 05 06:54:00 CST 2016, time=2016-09-05, status=1, ipAttribution=)]
    2016-09-05 医张生

    就是不能强化降压。但是有个底线

    0

  9. 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authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Mon Sep 05 09:25:00 CST 2016, time=2016-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=111177, encodeId=b4d61111e795, content=学习啦,,,,, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Mon Sep 05 09:25:00 CST 2016, time=2016-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=111153, encodeId=af0d111153fa, content=就是不能强化降压。但是有个底线, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=01bb1684217, createdName=医张生, createdTime=Mon Sep 05 08:54:00 CST 2016, time=2016-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=111113, encodeId=6a2711111356, content=强化减压, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=a37a1710612, createdName=oo902, createdTime=Mon Sep 05 07:08:00 CST 2016, time=2016-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=111108, encodeId=7f6411110806, content=好好学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Mon Sep 05 06:54:00 CST 2016, time=2016-09-05, status=1, ipAttribution=)]
    2016-09-05 oo902

    强化减压

    0

  10. 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06 07:02:00 CST 2016, time=2016-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1419072, encodeId=3f7514190e2ad, content=<a href='/topic/show?id=e051501461d' target=_blank style='color:#2F92EE;'>#强化降压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50146, encryptionId=e051501461d, topicName=强化降压)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2c6c3470765, createdName=fengxx, createdTime=Tue Sep 06 04:51:00 CST 2016, time=2016-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1291883, encodeId=1d571291883b4, content=<a href='/topic/show?id=9d32981418b' target=_blank style='color:#2F92EE;'>#降压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98141, encryptionId=9d32981418b, topicName=降压)], 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createdName=忠诚向上, createdTime=Mon Sep 05 06:54:00 CST 2016, time=2016-09-05, status=1, ipAttribution=)]
    2016-09-05 忠诚向上

    好好学习一下

    0

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