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NEJM:卵圆孔未闭封堵术vs抗血小板,抗血小板vs抗凝

2017-10-05 杨中华 脑血管病及重症文献导读

病例对照研究显示卵圆孔未闭(PFO)与隐源性卒中有关,特别是年龄小于55岁和合并房间隔动脉瘤或大量右向左分流的患者。在这些患者中,关闭PFO预防卒中复发的疗效尚不清楚。闭合卵圆孔理论上应该能够降低卒中复发风险,但是几项随机对照试验并没有发现PFO闭合优于抗栓治疗。


病例对照研究显示卵圆孔未闭(PFO)与隐源性卒中有关,特别是年龄小于55岁和合并房间隔动脉瘤或大量右向左分流的患者。在这些患者中,关闭PFO预防卒中复发的疗效尚不清楚。闭合卵圆孔理论上应该能够降低卒中复发风险,但是几项随机对照试验并没有发现PFO闭合优于抗栓治疗。

2017年9月来自法国的J.-L. Mas等在NEJM上公布了CLOSE试验结果,目的是为了探讨在预防卒中复发方面:1.经导管闭合PFO联合长期抗血小板治疗是否优于单独抗血小板治疗,2.口服抗凝治疗是否优于抗血小板治疗。

CLOSE为研究者发起、多中心、随机对照、开放标签、优效试验,研究从2007年12月(译者注:NEJM也出错,前后文时间错误,后面说2008年开始)开始到2016年12月结束。纳入标准包括:年龄16-60岁,6个月内发生过缺血性卒中,合并PFO联合房间隔动脉瘤或大量右向左分流,没有找到其他病因(未进行>=30天心电图监测)。大量分流定义为右心浊化(opacification)后3个心动周期检测到左心房微气泡数量超过30个。房间隔动脉瘤定义为经食道超声发现隔膜运动超过10mm(译者注:感觉翻译的别扭。原文 Atrial septal aneurysm was diagnosed on the basis of a septum primum excursion greater than 10 mm)。

纳入的患者根据患者是否存在抗凝和PFO封堵术禁忌症分为三个随机组:无抗栓禁忌症者进入随机组1,按照1:1:1的比例分别给予PFO封堵术联合长期抗血小板治疗(PFO封堵术组)或单独抗血小板组或单独口服抗凝组;口服抗凝剂禁忌症者进入随机组2,随机给予PFO封堵术联合抗血小板治疗(PFO封堵术组)或单独抗血小板组;PFO封堵术禁忌症者进入随机组3,随机给予单独口服抗凝组或单独抗血小板组。

所有纳入PFO封堵术组的患者都给予双抗治疗(阿司匹林联合氯吡格雷各75mg)共3个月,随后改为单抗治疗(具体选择药物见下)。口服抗凝组可以选择VitK拮抗剂(INR 2-3)或直接口服抗凝剂(direct oral anticoagulants. 译者注:这个是什么?新型口服抗凝剂?)。单独抗血小板组或PFO封堵术三个月后可以给予阿司匹林、氯吡格雷或阿司匹林联合缓释双嘧达莫。

该研究的主要有效性终点为致死性或非致死性卒中复发。安全性终点为严重或致死性手术或出血并发症。

该研究共纳入663例患者,随访平均5.3+-2年。在随机组1和2的分析中,PFO封堵术组和单独抗血小板组卒中卒中发生率分别为0%和14/235(HR, 0.03; 95% CI, 0 to 0.26; P<0.001)。PFO封堵术组手术并发症发生率为5.9%。PFO封堵术组房颤发生率明显高于单独抗血小板组(4.6% vs. 0.9%, P = 0.02)。治疗组间严重不良事件没有显著性差异(P = 0.56)。在随机组1和3的分析中,单独抗凝组和单独抗血小板组卒中复发率分别为3/187和7/174。

最终作者认为对于PFO合并房间隔动脉瘤或大量右向左分流的所致隐源性卒中患者,与单独抗血小板相比PFO封堵术联合抗血小板治疗的患者卒中复发率较低,每治疗20例患者5年间能预防一次卒中。PFO封堵术与房颤风险增加有关。另外作者还发现大部分卒中都发生在PFO联合房间隔动脉瘤的患者,这个发现与作者以前观察性研究结果一致。

以前发表过3项关于PFO的随机试验,都没有发现PFO封堵术预防卒中复发优于单独内科治疗。但是,其中两项研究提示PFO封堵术有获益的可能性,尽管结果没有达到显著性差异,其HR分别为0.2(95% CI,0.02 - 1.72),0.49(95% CI,0.22 - 1.11)。此外,这三项试验的pooled分析显示PFO封堵术者卒中复发风险明显低于内科治疗组。

CLOSE研究中PFO封堵术组房颤发生率明显高于单独抗血小板治疗组,但是大部分发生在手术后1个月内,这说明房颤是手术本身引起的。不能证明卒中复发和PFO封堵术诱发房颤有关。

以前的研究发现PFO患者采用抗凝治疗预防卒中复发优于抗血小板药物,但是CLOSE研究没有发现这个结果。

作者认为本研究结果不同于以前的研究,其原因主要是1.本研究纳入的患者为与PFO有关的隐源性卒中;2.采用了标准化评价流程定义隐源性卒中,这样卒中复发的病因大都是PFO而不是其他病因;3.CLOSE研究中患的危险因素较以前的研究更少;4.CLOSE试验中对照组只给予了抗血小板治疗,不同于以前的研究可以选择抗血小板药物也可以选择口服抗凝剂。

原始出处:

Mas JL, Derumeaux G, Guillon B,et al.Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke.N Engl J Med. 2017 Sep 14;377(11):1011-1021. doi: 10.1056/NEJMoa1705915.

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  1. [GetPortalCommentsPageByObjectIdResponse(id=2060979, encodeId=273420609e988, content=<a href='/topic/show?id=e70046e74d3' target=_blank style='color:#2F92EE;'>#封堵术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46774, encryptionId=e70046e74d3, topicName=封堵术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c805395, createdName=ycmayy, createdTime=Wed Dec 27 18:47:00 CST 2017, time=2017-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=251177, encodeId=31ab2511e7b6, content=非常好的文章.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Sat Oct 07 18:58:22 CST 2017, time=2017-10-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=251046, encodeId=53e125104621, content=学习了谢谢分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Sat Oct 07 09:12:55 CST 2017, time=2017-10-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250725, encodeId=df3d250e25fa, content=学习了新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Fri Oct 06 08:06:44 CST 2017, time=2017-10-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250678, encodeId=d6142506e8b1, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/09/07/a9772c74ffd6edc03a7f9af07b4747f6.jpg, createdBy=b3722138742, createdName=sunfeifeiyang, createdTime=Fri Oct 06 06:55:10 CST 2017, time=2017-10-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250630, encodeId=b63f250630da, content=这篇文章结果是支持封堵的-- 可以放心封堵了-, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c8b81637671, createdName=awesome, createdTime=Thu Oct 05 22:15:15 CST 2017, time=2017-10-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250613, encodeId=04fb25061358, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Oct 05 20:51:54 CST 2017, time=2017-10-05, status=1, ipAttribution=)]
    2017-12-27 ycmayy
  2. [GetPortalCommentsPageByObjectIdResponse(id=2060979, encodeId=273420609e988, content=<a href='/topic/show?id=e70046e74d3' target=_blank style='color:#2F92EE;'>#封堵术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46774, encryptionId=e70046e74d3, topicName=封堵术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c805395, createdName=ycmayy, createdTime=Wed Dec 27 18:47:00 CST 2017, time=2017-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=251177, encodeId=31ab2511e7b6, content=非常好的文章.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Sat Oct 07 18:58:22 CST 2017, time=2017-10-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=251046, encodeId=53e125104621, content=学习了谢谢分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Sat Oct 07 09:12:55 CST 2017, time=2017-10-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250725, encodeId=df3d250e25fa, content=学习了新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Fri Oct 06 08:06:44 CST 2017, time=2017-10-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250678, encodeId=d6142506e8b1, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/09/07/a9772c74ffd6edc03a7f9af07b4747f6.jpg, createdBy=b3722138742, createdName=sunfeifeiyang, createdTime=Fri Oct 06 06:55:10 CST 2017, time=2017-10-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250630, encodeId=b63f250630da, content=这篇文章结果是支持封堵的-- 可以放心封堵了-, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c8b81637671, createdName=awesome, createdTime=Thu Oct 05 22:15:15 CST 2017, time=2017-10-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250613, encodeId=04fb25061358, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Oct 05 20:51:54 CST 2017, time=2017-10-05, status=1, ipAttribution=)]
    2017-10-07 天涯183

    非常好的文章.学习了

    0

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    2017-10-07 大爰

    学习了谢谢分享!!

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=2060979, encodeId=273420609e988, content=<a href='/topic/show?id=e70046e74d3' target=_blank style='color:#2F92EE;'>#封堵术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46774, encryptionId=e70046e74d3, topicName=封堵术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c805395, createdName=ycmayy, createdTime=Wed Dec 27 18:47:00 CST 2017, time=2017-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=251177, encodeId=31ab2511e7b6, content=非常好的文章.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Sat Oct 07 18:58:22 CST 2017, time=2017-10-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=251046, encodeId=53e125104621, content=学习了谢谢分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Sat Oct 07 09:12:55 CST 2017, time=2017-10-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250725, encodeId=df3d250e25fa, content=学习了新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Fri Oct 06 08:06:44 CST 2017, time=2017-10-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250678, encodeId=d6142506e8b1, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/09/07/a9772c74ffd6edc03a7f9af07b4747f6.jpg, createdBy=b3722138742, createdName=sunfeifeiyang, createdTime=Fri Oct 06 06:55:10 CST 2017, time=2017-10-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250630, encodeId=b63f250630da, content=这篇文章结果是支持封堵的-- 可以放心封堵了-, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c8b81637671, createdName=awesome, createdTime=Thu Oct 05 22:15:15 CST 2017, time=2017-10-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250613, encodeId=04fb25061358, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Oct 05 20:51:54 CST 2017, time=2017-10-05, status=1, ipAttribution=)]
    2017-10-06 Y—xianghai

    学习了新知识

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=2060979, encodeId=273420609e988, content=<a href='/topic/show?id=e70046e74d3' target=_blank style='color:#2F92EE;'>#封堵术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46774, encryptionId=e70046e74d3, topicName=封堵术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c805395, createdName=ycmayy, createdTime=Wed Dec 27 18:47:00 CST 2017, time=2017-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=251177, encodeId=31ab2511e7b6, content=非常好的文章.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Sat Oct 07 18:58:22 CST 2017, time=2017-10-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=251046, encodeId=53e125104621, content=学习了谢谢分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Sat Oct 07 09:12:55 CST 2017, time=2017-10-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250725, encodeId=df3d250e25fa, content=学习了新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Fri Oct 06 08:06:44 CST 2017, time=2017-10-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250678, encodeId=d6142506e8b1, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/09/07/a9772c74ffd6edc03a7f9af07b4747f6.jpg, createdBy=b3722138742, createdName=sunfeifeiyang, createdTime=Fri Oct 06 06:55:10 CST 2017, time=2017-10-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250630, encodeId=b63f250630da, content=这篇文章结果是支持封堵的-- 可以放心封堵了-, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c8b81637671, createdName=awesome, createdTime=Thu Oct 05 22:15:15 CST 2017, time=2017-10-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250613, encodeId=04fb25061358, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Oct 05 20:51:54 CST 2017, time=2017-10-05, status=1, ipAttribution=)]
    2017-10-06 sunfeifeiyang

    学习

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=2060979, encodeId=273420609e988, content=<a href='/topic/show?id=e70046e74d3' target=_blank style='color:#2F92EE;'>#封堵术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46774, encryptionId=e70046e74d3, topicName=封堵术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c805395, createdName=ycmayy, createdTime=Wed Dec 27 18:47:00 CST 2017, time=2017-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=251177, encodeId=31ab2511e7b6, content=非常好的文章.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Sat Oct 07 18:58:22 CST 2017, time=2017-10-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=251046, encodeId=53e125104621, content=学习了谢谢分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Sat Oct 07 09:12:55 CST 2017, time=2017-10-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250725, encodeId=df3d250e25fa, content=学习了新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Fri Oct 06 08:06:44 CST 2017, time=2017-10-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250678, encodeId=d6142506e8b1, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/09/07/a9772c74ffd6edc03a7f9af07b4747f6.jpg, createdBy=b3722138742, createdName=sunfeifeiyang, createdTime=Fri Oct 06 06:55:10 CST 2017, time=2017-10-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250630, encodeId=b63f250630da, content=这篇文章结果是支持封堵的-- 可以放心封堵了-, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c8b81637671, createdName=awesome, createdTime=Thu Oct 05 22:15:15 CST 2017, time=2017-10-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250613, encodeId=04fb25061358, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Oct 05 20:51:54 CST 2017, time=2017-10-05, status=1, ipAttribution=)]
    2017-10-05 awesome

    这篇文章结果是支持封堵的-- 可以放心封堵了-

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=2060979, encodeId=273420609e988, content=<a href='/topic/show?id=e70046e74d3' target=_blank style='color:#2F92EE;'>#封堵术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46774, encryptionId=e70046e74d3, topicName=封堵术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c805395, createdName=ycmayy, createdTime=Wed Dec 27 18:47:00 CST 2017, time=2017-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=251177, encodeId=31ab2511e7b6, content=非常好的文章.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Sat Oct 07 18:58:22 CST 2017, time=2017-10-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=251046, encodeId=53e125104621, content=学习了谢谢分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Sat Oct 07 09:12:55 CST 2017, time=2017-10-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250725, encodeId=df3d250e25fa, content=学习了新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Fri Oct 06 08:06:44 CST 2017, time=2017-10-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250678, encodeId=d6142506e8b1, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/09/07/a9772c74ffd6edc03a7f9af07b4747f6.jpg, createdBy=b3722138742, createdName=sunfeifeiyang, createdTime=Fri Oct 06 06:55:10 CST 2017, time=2017-10-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250630, encodeId=b63f250630da, content=这篇文章结果是支持封堵的-- 可以放心封堵了-, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c8b81637671, createdName=awesome, createdTime=Thu Oct 05 22:15:15 CST 2017, time=2017-10-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=250613, encodeId=04fb25061358, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Oct 05 20:51:54 CST 2017, time=2017-10-05, status=1, ipAttribution=)]
    2017-10-05 清风拂面

    谢谢分享.学习了

    0

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