Heart：心衰合并房颤患者口服抗凝药使用不足的原因与后果

2018-07-23 王淳环球医学

2018年7月，发表在《Heart》的一项研究由瑞典学者进行的研究，考察了心衰合并房颤患者口服抗凝药使用不足的原因和后果。

2018年7月，发表在《Heart》的一项研究由瑞典学者进行的研究，考察了心衰合并房颤患者口服抗凝药使用不足的原因和后果。

目的：心衰患者常见房颤，应该使用口服抗凝药（OAC）。本研究旨在评估OAC使用不足的流行程度、预测因素和后果。

方法：研究人员从瑞典心衰注册中纳入了既往未行瓣膜置换术的房颤合并心衰患者。高和低的CHA2DS2-VASc和HAS-BLED评分被定义为中位值上/下。多变量逻辑回归用于评估基线特征和OAC使用之间的相关性，以及CHA2DS2-VASc和HAS-BLED评分与OAC使用之间的相关性。多变量Cox回归用于评估CHA2DS2-VASc和HAS-BLED评分、OAC使用和两个复合结局（全因死亡/卒中和全因死亡/大出血）之间的相关性。

结果：21865名患者中，仅有12659人（58%）接受了OAC。不使用OAC的预测因素为接受了血小板抑制剂治疗、较少心衰治疗、阵发性房颤、出血史、无既往卒中、计划在初级医疗中随访、高龄、独居、收入较低、与更严重心衰相关的因素。

对于CHA2DS2-VASc和HAS-BLED评分每增加1分，OAC的使用几率（95% 置信区间[CI]）分别为1.24（1.21~1.27）和0.32（0.30~0.33），死亡/卒中的HR为1.08（1.06~1.10），死亡/大出血的HR为1.18（1.15~1.21）。对于高vs低CHA2DS2-VASc和HAS-BLED评分，OAC使用的OR分别为1.23（1.15~1.32）和0.20（0.19~0.21），死亡/卒中HR为1.25（1.19~1.30），死亡/大出血HR为1.28（1.21~1.34）。

结论：合并心衰的房颤患者可基于合理理由而不接受OAC。对于决策制定，出血风险比卒中风险可造成更多的不利影响。

原始出处;

Dragos Vinereanu, Alice Wang, Hillary Mulder, et.al. Outcomes in anticoagulated patients with atrial fibrillation and with mitral or aortic valve disease. Heart Volume 104, Issue 15

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2018-07-26 jyzxjiangqin

心衰患者与房颤风险管理。

104 0
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2018-07-26 jyzxjiangqin

心衰患者与房颤风险管理。

78 0
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2018-07-26 1771ae4158m

借鉴大家经验很棒

75 0
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createdName=zhaojie88, createdTime=Wed Jul 25 05:24:00 CST 2018, time=2018-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1377409, encodeId=da8313e7409ee, content=<a href='/topic/show?id=3098382134a' target=_blank style='color:#2F92EE;'>#口服抗凝药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38213, encryptionId=3098382134a, topicName=口服抗凝药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=49ef408, createdName=hunizi005, createdTime=Wed Jul 25 05:24:00 CST 2018, time=2018-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562945, encodeId=550e156294550, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Wed Jul 25 05:24:00 CST 2018, time=2018-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614460, encodeId=89a81614460ed, content=<a href='/topic/show?id=64f95426122' target=_blank style='color:#2F92EE;'>#房颤患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54261, encryptionId=64f95426122, topicName=房颤患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=937e19519012, createdName=hittouch, createdTime=Wed Jul 25 05:24:00 CST 2018, time=2018-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=333771, encodeId=09b4333e71b1, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Tue Jul 24 07:07:38 CST 2018, time=2018-07-24, status=1, ipAttribution=)]
2018-07-26 1771ae4158m

跟大家学习很好

84 0
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topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Tue Jul 24 07:07:38 CST 2018, time=2018-07-24, status=1, ipAttribution=)]
2018-07-26 1771ae4158m

学习一下很不错

82 0
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createdName=zhaojie88, createdTime=Wed Jul 25 05:24:00 CST 2018, time=2018-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1377409, encodeId=da8313e7409ee, content=<a href='/topic/show?id=3098382134a' target=_blank style='color:#2F92EE;'>#口服抗凝药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38213, encryptionId=3098382134a, topicName=口服抗凝药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=49ef408, createdName=hunizi005, createdTime=Wed Jul 25 05:24:00 CST 2018, time=2018-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562945, encodeId=550e156294550, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Wed Jul 25 05:24:00 CST 2018, time=2018-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614460, encodeId=89a81614460ed, content=<a href='/topic/show?id=64f95426122' target=_blank style='color:#2F92EE;'>#房颤患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54261, encryptionId=64f95426122, topicName=房颤患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=937e19519012, createdName=hittouch, createdTime=Wed Jul 25 05:24:00 CST 2018, time=2018-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=333771, encodeId=09b4333e71b1, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Tue Jul 24 07:07:38 CST 2018, time=2018-07-24, status=1, ipAttribution=)]
2018-07-25 zhaojie88

#ART#

68 0
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encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Wed Jul 25 05:24:00 CST 2018, time=2018-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614460, encodeId=89a81614460ed, content=<a href='/topic/show?id=64f95426122' target=_blank style='color:#2F92EE;'>#房颤患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54261, encryptionId=64f95426122, topicName=房颤患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=937e19519012, createdName=hittouch, createdTime=Wed Jul 25 05:24:00 CST 2018, time=2018-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=333771, encodeId=09b4333e71b1, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Tue Jul 24 07:07:38 CST 2018, time=2018-07-24, status=1, ipAttribution=)]
2018-07-25 hunizi005

#口服抗凝药#

72 0
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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=334294, encodeId=16713342944d, content=借鉴大家经验很棒, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, 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=Thu Jul 26 10:48:52 CST 2018, time=2018-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=334293, encodeId=1ce433429350, content=跟大家学习很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, 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=Thu Jul 26 10:48:42 CST 2018, time=2018-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=334292, encodeId=2516334292ec, content=学习一下很不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, 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=Thu Jul 26 10:48:35 CST 2018, time=2018-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1356861, encodeId=9dbf135686165, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Wed Jul 25 05:24:00 CST 2018, time=2018-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1377409, encodeId=da8313e7409ee, content=<a href='/topic/show?id=3098382134a' target=_blank style='color:#2F92EE;'>#口服抗凝药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38213, encryptionId=3098382134a, topicName=口服抗凝药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=49ef408, createdName=hunizi005, createdTime=Wed Jul 25 05:24:00 CST 2018, time=2018-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562945, encodeId=550e156294550, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Wed Jul 25 05:24:00 CST 2018, time=2018-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614460, encodeId=89a81614460ed, content=<a href='/topic/show?id=64f95426122' target=_blank style='color:#2F92EE;'>#房颤患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54261, encryptionId=64f95426122, topicName=房颤患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=937e19519012, createdName=hittouch, createdTime=Wed Jul 25 05:24:00 CST 2018, time=2018-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=333771, encodeId=09b4333e71b1, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Tue Jul 24 07:07:38 CST 2018, time=2018-07-24, status=1, ipAttribution=)]
2018-07-25 slcumt

#HEART#

74 0
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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=334294, encodeId=16713342944d, content=借鉴大家经验很棒, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, 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=Thu Jul 26 10:48:52 CST 2018, time=2018-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=334293, encodeId=1ce433429350, content=跟大家学习很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, 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=Thu Jul 26 10:48:42 CST 2018, time=2018-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=334292, encodeId=2516334292ec, content=学习一下很不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, 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=Thu Jul 26 10:48:35 CST 2018, time=2018-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1356861, encodeId=9dbf135686165, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Wed Jul 25 05:24:00 CST 2018, time=2018-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1377409, encodeId=da8313e7409ee, content=<a href='/topic/show?id=3098382134a' target=_blank style='color:#2F92EE;'>#口服抗凝药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38213, encryptionId=3098382134a, topicName=口服抗凝药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=49ef408, createdName=hunizi005, createdTime=Wed Jul 25 05:24:00 CST 2018, time=2018-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562945, encodeId=550e156294550, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Wed Jul 25 05:24:00 CST 2018, time=2018-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614460, encodeId=89a81614460ed, content=<a href='/topic/show?id=64f95426122' target=_blank style='color:#2F92EE;'>#房颤患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54261, encryptionId=64f95426122, topicName=房颤患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=937e19519012, createdName=hittouch, createdTime=Wed Jul 25 05:24:00 CST 2018, time=2018-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=333771, encodeId=09b4333e71b1, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Tue Jul 24 07:07:38 CST 2018, time=2018-07-24, status=1, ipAttribution=)]
2018-07-25 hittouch

#房颤患者#

65 0
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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=334294, encodeId=16713342944d, content=借鉴大家经验很棒, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, 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=Thu Jul 26 10:48:52 CST 2018, time=2018-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=334293, encodeId=1ce433429350, content=跟大家学习很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, 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=Thu Jul 26 10:48:42 CST 2018, time=2018-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=334292, encodeId=2516334292ec, content=学习一下很不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, 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=Thu Jul 26 10:48:35 CST 2018, time=2018-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1356861, encodeId=9dbf135686165, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Wed Jul 25 05:24:00 CST 2018, time=2018-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1377409, encodeId=da8313e7409ee, content=<a href='/topic/show?id=3098382134a' target=_blank style='color:#2F92EE;'>#口服抗凝药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38213, encryptionId=3098382134a, topicName=口服抗凝药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=49ef408, createdName=hunizi005, createdTime=Wed Jul 25 05:24:00 CST 2018, time=2018-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562945, encodeId=550e156294550, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Wed Jul 25 05:24:00 CST 2018, time=2018-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614460, encodeId=89a81614460ed, content=<a href='/topic/show?id=64f95426122' target=_blank style='color:#2F92EE;'>#房颤患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54261, encryptionId=64f95426122, topicName=房颤患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=937e19519012, createdName=hittouch, createdTime=Wed Jul 25 05:24:00 CST 2018, time=2018-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=333771, encodeId=09b4333e71b1, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Tue Jul 24 07:07:38 CST 2018, time=2018-07-24, status=1, ipAttribution=)]
2018-07-24 张新亮1853311252142e2fm

好文献学习了

56 0

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