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AACE/ACE联合怒推《肥胖患者综合治疗临床实践指南》

2016-06-03 图片鉴赏师 医学界内分泌频道

2016年美国临床内分泌医师协会(AACE)年会上宣布,AACE与美国内分泌协会(ACE)联合制定的《肥胖患者综合治疗临床实践指南》已于5月24日在线发表于AACE的官方杂志Endocrine Practice。

2016年美国临床内分泌医师协会(AACE)年会上宣布,AACE与美国内分泌协会(ACE)联合制定的《肥胖患者综合治疗临床实践指南》已于5月24日在线发表于AACE的官方杂志Endocrine Practice。

温故知新:

2016年版的新指南在2014年指南的基础上进行了扩充,包括了筛查、诊断、评估、治疗策略、治疗目标和随访等。

新版指南认为,肥胖是一种慢性疾病,并对其进行了分期(0~2期),认为对其的管理不能仅仅局限于“减重”这一个方面,而是应该包括改善健康在内的方方面面,比如生活方式干预、何时使用减重药物或减肥手术治疗等,共涉及123条建议,其中A级、B级、C级和D级的推荐分别为85(53.1%) 、48(30.0%)、11(6.9%)和16(10.0%)。

与2013年美国心脏病学学会/美国心脏协会/美国肥胖学会(ACC/AHA/OS)发布的肥胖指南相比,AACE的指南回答了有明确数据定义的9个问题,而ACC/AHA/OS的指南回答了5个问题。此外,距离ACC/AHA/OS的肥胖指南发布已有一段时间,远不能满足当今市场的需求。


新版指南中推荐等级为A级的要点:

1、肥胖的筛查:建议所有成年人每年一次,以BMI≥25kg/m2为界,其中BMI处于25~29.9 kg/m2之间为超重,BMI ≥30 kg/m2为肥胖。同时还要结合年龄、性别、种族、体液情况和肌肉等做出综合判断;

2、评估肥胖相关疾病风险时,应测量所有BMI <35 kg/m2者的腰围,男性以≥94 cm、女性以≥80 cm为是否存在腹部肥胖的界限,其中美国和加拿大以男性≥102 cm、女性≥88 cm作为风险增加的阈值;

3、超重或肥胖患者出现体重进行性增加时,应通过腰围、空腹血糖、HbA1c、血压和血脂等筛查前驱糖尿病、2型糖尿病代谢综合征高血压、心血管疾病等风险;

4、应评估2型糖尿病、血脂异常、高血压、心血管疾病等患者是否存在超重或肥胖;

5、超重或肥胖并伴有代谢综合征或2型糖尿病等疾病高风险的患者,应对生活方式进行干预,包括减少卡路里摄入的健康饮食、联合有氧和无氧体育锻炼,并以体重下降10%为目标;

6、结合生活方式干预,可以使用的减肥药物有苯丁胺/托吡酯ER,利拉鲁肽3毫克或奥利司他,从而帮助2型糖尿病高风险人群达到减重10%的目标;

7、前驱糖尿病高风险人群使用生活方式干预、减肥药物等后效果不理想, 可使用二甲双胍、阿卡波糖、噻唑烷二酮类等糖尿病治疗药物;

8、确诊为2型糖尿病的超重或肥胖患者应改变生活方式,达到体重下降5%~15%的目的,甚至降低HbA1c水平。不考虑2型糖尿病的病程和严重程度,患者均应考虑减重治疗。减重药物可以作为这类患者改善血糖、血脂和血压的辅助治疗手段;确诊为2型糖尿病的肥胖(BMI ≥30 kg/m2)患者,当改善生活方式、使用减肥药物等均不能有所改善时,应考虑减重手术;

9、超重或肥胖的血脂异常患者,应通过改变生活方式、结合减肥药辅助等手段达到体重下降5%~10%的目标,同时能够改善患者的血脂情况;


10、超重或肥胖的高血压患者,应通过改变生活方式、结合减肥药辅助等手段达到体重下降5%~10%的目标;效果不显著者,可以考虑减肥手术;

11、超重或肥胖的非酒精性脂肪肝患者,应通过改变生活方式、结合减肥药辅助等手段达到体重下降4%~10%的目标;当体重下降10%~40%时,可以降低肝炎、肝细胞损伤和肝硬化风险;推荐该类患者采用地中海饮食;

12、超重或肥胖的PCOS患者,应通过改变生活方式、结合减肥药辅助等手段达到体重下降5%~15%的目标,同时可以改善胰岛素抵抗等情况;效果不显著者,可以考虑减肥手术;

13、超重或肥胖的不孕不育患者,应通过改变生活方式、结合减肥药辅助等手段达到体重下降10%以上的目标;

14、伴性腺功能减退症的肥胖和2型糖尿病患者,推荐减肥手术治疗;

15、伴性腺功能减退症的男性肥胖患者推荐睾酮联合生活方式干预治疗;

16、超重或肥胖的阻塞性睡眠呼吸暂停患者,应通过改变生活方式、结合减肥药辅助等手段达到体重下降7%~11%的目标;

17、超重或肥胖的哮喘患者,应通过改变生活方式、结合减肥药辅助等手段达到体重下降7%~8%的目标;

18、超重或肥胖的骨关节炎患者,减重目标为5%~10%;如果出现体重相关关节损伤,减重目标则在10%以上;

19、超重或肥胖的尿失禁患者,减重目标为5%~10%或更多;

20、超重或肥胖的胃食管反流患者,减重目标在10%以上,可结合减肥药物和PPI治疗,还可考虑减肥手术。胃内放置气球会加重胃食管反流症状,故不对该类患者使用;

21、对减重感兴趣的超重或肥胖抑郁患者,应提供给患者一个结构化的生活方式干预;


22、减少卡路里摄入是饮食干预的核心;

23、锻炼应达到每周3~5天里共进行≥150分钟的中等强度有氧运动目标,每周推荐2~3次阻力训练,并改变久坐不动的生活方式;

24、早期减重效果可以预测长期的减重结局。如果治疗的第一个月患者的体重没有下降2.5%,则应该加强生活方式干预和支持治疗;

25、减肥药物只能作为生活方式干预的辅助治疗,不能单独使用;

26、不管选择何种治疗方式,临床医生应对胆石症高风险保持高度警惕,谨慎使用利拉鲁肽3 mg。有效的预防措施包括:缓慢减重、增加饮食脂肪,或给予熊去氧胆酸;

27、使用利拉鲁肽3 mg和芬特明/托吡酯ER时监测患者心率;

28、肾素-血管紧张素系统抑制治疗是肥胖高血压患者控制血压的首选,其与钙通道阻滞剂联合使用可作为二线选择;β受体阻滞剂和噻嗪类利尿剂在一些情况下也可以考虑,但是它们也会带来代谢相关的副作用:β和α受体阻滞剂会引起体重增加;

29、动脉粥样硬化性心血管疾病患者,优先选择奥利司他与氯卡色林这两种减肥药物;其次选利拉鲁肽3 mg、芬特明/托吡酯ER、安非他酮和纳曲酮,但需要检测心率和血压;

30、对所有减肥治疗的患者均应监测精神状态、抑郁和自杀意念等。伴抑郁的肥胖患者的治疗考虑奥利司他、利拉鲁肽3 mg、芬特明/托吡酯ER(初始:3.75 mg/23 mg、治疗:7.5 mg/46 mg),避免使用安非他酮和纳曲酮;

31、伴焦虑的肥胖患者可使用的芬特明/托吡酯ER的最大剂量为15 mg/92 mg;

32、服用抗精神病药物的精神病性障碍患者使用二甲双胍可改善代谢,有利于体重的下降;


33、患有暴饮暴食症的超重或肥胖者,除了结构化的行为和生活方式干预外,还需联合认知行为疗法或其他心理干预治疗;

34、对所有的肥胖患者应监测典型的胰腺炎症状;

35、孕期不能使用减肥药物;育龄期女性减肥药应与避孕药联用;

36、老年患者使用减肥药物应格外谨慎;

37、酒精或其他成瘾的肥胖患者,应选择奥利司他、利拉鲁肽3 mg;避免氯卡色林、纳曲酮ER/安非他酮ER;

38、减肥手术后也要继续生活方式干预。

参考文献:
1.W. Timothy Garvey,Jeffrey I. Mechanick, AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY CLINICAL PRACTICE GUIDELINES FOR COMPREHENSIVE MEDICAL CARE OF PATIENTS WITH OBESITY – EXECUTIVE SUMMARY.Endocr Pract. 2016 May 24. [Epub ahead of print]
2.Miriam E Tucker.New AACE Guidelines Aim for 'Real-World' Obesity Management.Medscape.May 26, 2016

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    2017-01-15 zgwhgch
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  5. 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createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Jun 05 11:54:00 CST 2016, time=2016-06-05, status=1, ipAttribution=)]
    2016-09-21 1e10c84am36(暂无匿称)

    文章很好,非常有益

    0

  6. 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channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=53751677671, createdName=沉心多思, createdTime=Sun Jun 05 21:20:00 CST 2016, time=2016-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=88546, encodeId=72a088546a4, content=不错的文章,多学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=53751677671, createdName=沉心多思, createdTime=Sun Jun 05 14:55:00 CST 2016, time=2016-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=88472, encodeId=5a37884e2b1, content=好好学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Jun 05 11:54:00 CST 2016, time=2016-06-05, status=1, ipAttribution=)]
    2016-09-15 舒心和人

    肥胖好可怕,全球化

    0

  7. 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topicList=[TopicDto(id=46072, encryptionId=5df2460e269, topicName=实践指南)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=796422, createdName=lvliquan, createdTime=Thu Mar 23 01:02:00 CST 2017, time=2017-03-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=132220, encodeId=47ea132220d6, content=文章很好,非常有益, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Wed Sep 21 09:00:00 CST 2016, time=2016-09-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=127516, encodeId=21b412e516c7, content=肥胖好可怕,全球化, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160907/IMG57D00CF1965701770.jpg, createdBy=565c1948251, createdName=舒心和人, createdTime=Thu Sep 15 14:12:00 CST 2016, time=2016-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1646838, encodeId=b1731646838a7, content=<a href='/topic/show?id=91cfe913977' target=_blank style='color:#2F92EE;'>#综合治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79139, encryptionId=91cfe913977, topicName=综合治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=690523366225, createdName=zhaohui6739, createdTime=Tue Jun 07 00:02:00 CST 2016, time=2016-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=88672, encodeId=0ec2886e2c4, content=不错的文章,多学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=53751677671, createdName=沉心多思, createdTime=Sun Jun 05 21:20:00 CST 2016, time=2016-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=88546, encodeId=72a088546a4, content=不错的文章,多学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=53751677671, createdName=沉心多思, createdTime=Sun Jun 05 14:55:00 CST 2016, time=2016-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=88472, encodeId=5a37884e2b1, content=好好学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Jun 05 11:54:00 CST 2016, time=2016-06-05, status=1, ipAttribution=)]
  8. [GetPortalCommentsPageByObjectIdResponse(id=1655748, encodeId=1f641655e48b8, content=<a href='/topic/show?id=2a011829d7' target=_blank style='color:#2F92EE;'>#ACE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1829, encryptionId=2a011829d7, topicName=ACE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=635024767990, createdName=shanyongle, createdTime=Fri Jan 06 11:02:00 CST 2017, time=2017-01-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1699195, encodeId=1f3e1699195a5, content=<a href='/topic/show?id=1349166054' target=_blank style='color:#2F92EE;'>#AACE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1660, encryptionId=1349166054, topicName=AACE)], attachment=null, authenticateStatus=null, createdAvatar=null, 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topicList=[TopicDto(id=46072, encryptionId=5df2460e269, topicName=实践指南)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=796422, createdName=lvliquan, createdTime=Thu Mar 23 01:02:00 CST 2017, time=2017-03-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=132220, encodeId=47ea132220d6, content=文章很好,非常有益, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Wed Sep 21 09:00:00 CST 2016, time=2016-09-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=127516, encodeId=21b412e516c7, content=肥胖好可怕,全球化, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160907/IMG57D00CF1965701770.jpg, createdBy=565c1948251, createdName=舒心和人, createdTime=Thu Sep 15 14:12:00 CST 2016, time=2016-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1646838, encodeId=b1731646838a7, content=<a href='/topic/show?id=91cfe913977' target=_blank style='color:#2F92EE;'>#综合治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79139, encryptionId=91cfe913977, topicName=综合治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=690523366225, createdName=zhaohui6739, createdTime=Tue Jun 07 00:02:00 CST 2016, time=2016-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=88672, encodeId=0ec2886e2c4, content=不错的文章,多学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=53751677671, createdName=沉心多思, createdTime=Sun Jun 05 21:20:00 CST 2016, time=2016-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=88546, encodeId=72a088546a4, content=不错的文章,多学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=53751677671, createdName=沉心多思, createdTime=Sun Jun 05 14:55:00 CST 2016, time=2016-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=88472, encodeId=5a37884e2b1, content=好好学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Jun 05 11:54:00 CST 2016, time=2016-06-05, status=1, ipAttribution=)]
    2016-06-05 沉心多思

    不错的文章,多学习

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=1655748, encodeId=1f641655e48b8, content=<a href='/topic/show?id=2a011829d7' target=_blank style='color:#2F92EE;'>#ACE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1829, encryptionId=2a011829d7, topicName=ACE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=635024767990, createdName=shanyongle, createdTime=Fri Jan 06 11:02:00 CST 2017, time=2017-01-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1699195, encodeId=1f3e1699195a5, content=<a href='/topic/show?id=1349166054' target=_blank style='color:#2F92EE;'>#AACE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1660, encryptionId=1349166054, topicName=AACE)], attachment=null, authenticateStatus=null, createdAvatar=null, 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topicList=[TopicDto(id=46072, encryptionId=5df2460e269, topicName=实践指南)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=796422, createdName=lvliquan, createdTime=Thu Mar 23 01:02:00 CST 2017, time=2017-03-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=132220, encodeId=47ea132220d6, content=文章很好,非常有益, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Wed Sep 21 09:00:00 CST 2016, time=2016-09-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=127516, encodeId=21b412e516c7, content=肥胖好可怕,全球化, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160907/IMG57D00CF1965701770.jpg, createdBy=565c1948251, createdName=舒心和人, createdTime=Thu Sep 15 14:12:00 CST 2016, time=2016-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1646838, encodeId=b1731646838a7, content=<a href='/topic/show?id=91cfe913977' target=_blank style='color:#2F92EE;'>#综合治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79139, encryptionId=91cfe913977, topicName=综合治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=690523366225, createdName=zhaohui6739, createdTime=Tue Jun 07 00:02:00 CST 2016, time=2016-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=88672, encodeId=0ec2886e2c4, content=不错的文章,多学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=53751677671, createdName=沉心多思, createdTime=Sun Jun 05 21:20:00 CST 2016, time=2016-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=88546, encodeId=72a088546a4, content=不错的文章,多学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=53751677671, createdName=沉心多思, createdTime=Sun Jun 05 14:55:00 CST 2016, time=2016-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=88472, encodeId=5a37884e2b1, content=好好学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Jun 05 11:54:00 CST 2016, time=2016-06-05, status=1, ipAttribution=)]
    2016-06-05 沉心多思

    不错的文章,多学习

    0

  10. 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160907/IMG57D00CF1965701770.jpg, createdBy=565c1948251, createdName=舒心和人, createdTime=Thu Sep 15 14:12:00 CST 2016, time=2016-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1646838, encodeId=b1731646838a7, content=<a href='/topic/show?id=91cfe913977' target=_blank style='color:#2F92EE;'>#综合治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79139, encryptionId=91cfe913977, topicName=综合治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=690523366225, createdName=zhaohui6739, createdTime=Tue Jun 07 00:02:00 CST 2016, time=2016-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=88672, encodeId=0ec2886e2c4, content=不错的文章,多学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=53751677671, createdName=沉心多思, createdTime=Sun Jun 05 21:20:00 CST 2016, time=2016-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=88546, encodeId=72a088546a4, content=不错的文章,多学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=53751677671, createdName=沉心多思, createdTime=Sun Jun 05 14:55:00 CST 2016, time=2016-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=88472, encodeId=5a37884e2b1, content=好好学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Jun 05 11:54:00 CST 2016, time=2016-06-05, status=1, ipAttribution=)]
    2016-06-05 忠诚向上

    好好学习

    0

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