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SGLT2抑制剂临床应用专家指导建议解读:CDS2019

2019-11-22 小M MedSci原创

新型降糖药物如SGLT2抑制剂、DPP-4抑制剂、GLP1-RA陆续在国内上市,部分药品进入国家医保目录及国家基药目录,临床应用日趋广泛。广大一线基层医生缺乏对新型糖药物的药物特性、指南地位、临床获益、特殊人群应用及可能副作用的深入理解,严重制约药物合理应用。新型降糖药物的大型临床循证证据不断揭晓,相关基础研究不断深入,真实世界研究数据相继报道,如问综合且合理解读相关指南文献,服务临床实践,日

新型降糖药物如SGLT2抑制剂、DPP-4抑制剂、GLP1-RA陆续在国内上市,部分药品进入国家医保目录及国家基药目录,临床应用日趋广泛。广大一线基层医生缺乏对新型糖药物的药物特性、指南地位、临床获益、特殊人群应用及可能副作用的深入理解,严重制约药物合理应用。

新型降糖药物的大型临床循证证据不断揭晓,相关基础研究不断深入,真实世界研究数据相继报道,如问综合且合理解读相关指南文献,服务临床实践,日益困惑广大医生,为此,糖尿代谢性大血管病变学组(筹)组织专家编撰系列新型降糖药物临床应用专家指导建议,旨在突出实践,指导基层。

在11月20日-23日举办的中华医学会糖尿病学分会第二十三次全国学术会议(CDS 2019)年会上,解放军总医院第一医学中心内分泌科的窦京涛教授,针对SGLT2抑制剂临床应用专家指导建议进行了详细解读,主要归纳为六大类问题,在此小编整理精彩内容与大家分享。

一.SGLT2抑制剂的临床地位与基本信息

1. SGLT2抑制剂的作用机制是什么?
SGLT2抑制剂的作用机制:通过减少肾脏葡萄糖重吸收、降低肾糖阈,从而增加尿糖排泄,降低血糖
2. SGLT2抑制剂的的指南推荐地位如何?
2017年版《中国2型糖尿病防治指南》、2019年版ADA《糖尿病标准治疗》、2019年版ESC/EASD《糖尿病/糖尿病前期和心血管疾病指南》等国内外指南推荐:SGLT2抑制剂是2型糖尿病(T2DM)二联或三联治疗的优选药物,尤其当合并动脉粥样硬化性心血管病(ASCVD)或慢性肾脏疾病(CKD)时,或需要关注低血糖、体重增加风险时。

二.SGLT2抑制剂的代谢获益

SGLT2抑制剂是否具有多重代谢获益?
除降糖疗效确切外,SGLT2抑制剂兼具减重、降压、调节血脂、降尿酸的多重代谢获益。



三.SGLT2抑制剂对糖尿病大血管并发症的影响

已完成的心血管结局临床研究(CVOT)证实SGLT2抑制剂能显著降低具有心血管高危风险或合并心血管疾病的T2DM患者心血管主要不良事件(MACE)、因心衰住院或死亡的风险。

1.SGLT2抑制剂是否有心血管保护作用?
SGLT2抑制剂的心血管保护已被多项CVOT证实,可显著降低合并心血管高危风险或确诊心血管疾病的T2DM患者MACE(心血管死亡、非致死性心梗、非致死性卒中)、因心衰住院或死亡的风险。



2.SGLT2抑制剂对合并心衰患者是否有获益?
已完成的SGLT2抑制剂CVOT均显示SGLT2抑制剂的应用能够降低具有心血管高危风险的T2DM患者的心衰住院风险。对比标准治疗恩格列净、卡格列净及达格列净分别降低35%、33%和27%的心衰住院风险。
刚公布的DAPA-HF研究显示无论是否合并糖尿病达格列净均显著降低心血管死亡或因心衰住院或紧急就诊发生风险。



四.SGLT2抑制剂对糖尿病微血管并发症的影响

SGLT2抑制剂是否具有肾脏保护作用?
SGLT2抑制剂具有肾脏保护作用。卡格列净肾脏结局研究CREDENCE研究证实在糖尿病合并CKD患者中卡格列净具有肾脏获益:与标准治疗相比,卡格列净肾脏终点事件(终末期肾病、肌酐翻倍、肾性及心血管死亡)风险降低30%。



CVOT同样评估其肾脏相关终点,均观察到应用SGLT2抑制剂能使肾脏相关终点事件风险下降。

五.SGLT2抑制剂的安全性评价

贴合新型药物应用顾虑,特别设置整体安全性评价一章,直面药物使用中的不良反应。综合国内外指南文献,结合专家用药实践,简洁明确给出处置策略。



1.SGLT2抑制剂会增加低血糖风险吗?
SGLT2抑制剂不增加低血糖风险,与胰岛素或胰岛素促泌剂联用时低血糖风险可能增加。
处理策略:与胰岛素及促泌剂联用时应下调胰岛素或磺脲类降糖药物剂量。

2.SGLT2抑制剂是否增加泌尿生殖系统感染
SGLT2抑制剂轻度增加泌尿生殖系统感染,以轻至中度感染为主。
处理策略:半年内反复泌尿生殖感染者不推荐使用;注意个人外阴部卫生,适量增加饮水;使用中,尤其第一个月,关注泌尿及生殖系统感染症状和体征;如发生感染并需抗感染治疗时暂停SGLT2,感染治愈后,依病情考虑是否继续使用。

3.SGLT2抑制剂是否诱发糖尿病酮症酸中毒?
糖尿病酮症酸中毒(DKA)是SGLT2抑制剂不常见但严重的不良反应。SGLT2抑制剂所致的DKA可表现血糖轻度升高或正常,酮体来源于排糖、脂肪分解。
处理策略:联合胰岛素治疗时,避免随意停用胰岛素或过度降低剂量;急性应激状态(如感染、创伤)发生时暂停SGLT2抑制剂,应激状态解除后重新使用;减肥手术前低碳饮食时停用,术后重新评估是否能使用;大型手术前3天停用,术后可以进食且恢复良好后重新使用;有脱水风险时停用,直到不再脱水;酗酒时停用,之后重新评估。

4.SGLT2抑制剂与截肢风险关系?
SGLT2抑制剂与截肢风险关系不明确,各研究结果不一致。
处理策略:开始用药前应考虑可能增加截肢风险的因素,如截肢史、糖尿病性足部溃疡等;定期检查足部,并进行日常预防性足部护理;如出现下肢感染和新发疼痛、疮或溃疡并发症应停药,如发现足部有任何创口、变色或疼痛,应告知其医生。
5. SGLT2抑制剂可能出现的其他不良反应?



六.SGLT2抑制剂的临床应用

以药物准入适应症为准,特别说明特殊人群用药,直指临床应用最关注热点;根据联合用药顾虑,列出最常见药物联合应用注意事项。

1.特殊人群应注意是否有适应症、是否需要调整剂量



用药监测:建议开始SGLT2抑制剂治疗前:检测肾功能,并之后每年至少监测一次;当患者肾功能逐渐下降并趋向于中重度肾功能不全时:每年监测2-4次,同时关注血容量降低相关的不良事件。

2.肝肾功能受损患者中如何使用?
SGLT2抑制剂对CYP介导的代谢路径较弱,应根据肝功能受损程度调整;SGLT2抑制剂随肾功能下降而降低降糖疗效,无明显安全性问题。

总结

SGLT2抑制剂以其独特的降糖机制及心肾保护的循证证据,目前已成为国内外指南降糖治疗的二线联合方案之一,尤其对已患有ASCVD、心衰、慢性肾病,或存在此类疾病高风险因素的T2DM患者,SGLT2抑制剂或可作为降糖二联治疗方案的首选药物。合理应对及预判SGLT2抑制剂应用中的不良反应,提高临床规范诊疗水平,是此类药物发挥最大获益的最要基础,期待未来更多的降糖外获益机制的解析以及更多真实世界数据。

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1793835, encodeId=f1291e9383555, content=<a href='/topic/show?id=5a3f1621e7d' target=_blank style='color:#2F92EE;'>#SGLT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16217, encryptionId=5a3f1621e7d, topicName=SGLT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Tue Sep 01 15:59:00 CST 2020, time=2020-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1852185, encodeId=595f1852185a6, content=<a href='/topic/show?id=f0a254918f0' target=_blank style='color:#2F92EE;'>#抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Tue Aug 25 04:59:00 CST 2020, time=2020-08-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1835844, encodeId=cfd518358449f, content=<a href='/topic/show?id=cfdc22e893f' target=_blank style='color:#2F92EE;'>#临床应用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22789, encryptionId=cfdc22e893f, topicName=临床应用)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fc8528, createdName=clmlylxy, createdTime=Wed Sep 23 05:59:00 CST 2020, time=2020-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1995577, encodeId=9db019955e7db, content=<a href='/topic/show?id=992411149e' target=_blank style='color:#2F92EE;'>#2抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1114, encryptionId=992411149e, topicName=2抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28b7142, createdName=liuquan, createdTime=Wed Sep 30 06:59:00 CST 2020, time=2020-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1377636, encodeId=892713e763673, content=<a href='/topic/show?id=5dfe4420fc' target=_blank style='color:#2F92EE;'>#CDS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4420, encryptionId=5dfe4420fc, topicName=CDS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ec25412, createdName=yangpeizhi, createdTime=Sun Nov 24 09:59:00 CST 2019, time=2019-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1503794, encodeId=4bbe1503e9457, content=<a href='/topic/show?id=60b916226e1' target=_blank style='color:#2F92EE;'>#SGLT2#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16226, encryptionId=60b916226e1, topicName=SGLT2)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3afa9693555, createdName=jiekemin, createdTime=Sun Nov 24 09:59:00 CST 2019, time=2019-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=375663, encodeId=41fb3e5663e9, content=应该不错,不过泌尿系统感染仍不能忽视, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Fri Nov 22 19:59:29 CST 2019, time=2019-11-22, status=1, ipAttribution=)]
    2020-09-01 tulenzi
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    2020-08-25 jklm09
  3. [GetPortalCommentsPageByObjectIdResponse(id=1793835, encodeId=f1291e9383555, content=<a href='/topic/show?id=5a3f1621e7d' target=_blank style='color:#2F92EE;'>#SGLT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16217, encryptionId=5a3f1621e7d, topicName=SGLT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Tue Sep 01 15:59:00 CST 2020, time=2020-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1852185, encodeId=595f1852185a6, content=<a href='/topic/show?id=f0a254918f0' target=_blank style='color:#2F92EE;'>#抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Tue Aug 25 04:59:00 CST 2020, time=2020-08-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1835844, encodeId=cfd518358449f, content=<a href='/topic/show?id=cfdc22e893f' target=_blank style='color:#2F92EE;'>#临床应用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22789, encryptionId=cfdc22e893f, topicName=临床应用)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fc8528, createdName=clmlylxy, createdTime=Wed Sep 23 05:59:00 CST 2020, time=2020-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1995577, encodeId=9db019955e7db, content=<a href='/topic/show?id=992411149e' target=_blank style='color:#2F92EE;'>#2抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1114, encryptionId=992411149e, topicName=2抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28b7142, createdName=liuquan, createdTime=Wed Sep 30 06:59:00 CST 2020, time=2020-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1377636, encodeId=892713e763673, content=<a href='/topic/show?id=5dfe4420fc' target=_blank style='color:#2F92EE;'>#CDS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4420, encryptionId=5dfe4420fc, topicName=CDS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ec25412, createdName=yangpeizhi, createdTime=Sun Nov 24 09:59:00 CST 2019, time=2019-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1503794, encodeId=4bbe1503e9457, content=<a href='/topic/show?id=60b916226e1' target=_blank style='color:#2F92EE;'>#SGLT2#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16226, encryptionId=60b916226e1, topicName=SGLT2)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3afa9693555, createdName=jiekemin, createdTime=Sun Nov 24 09:59:00 CST 2019, time=2019-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=375663, encodeId=41fb3e5663e9, content=应该不错,不过泌尿系统感染仍不能忽视, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Fri Nov 22 19:59:29 CST 2019, time=2019-11-22, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=1793835, encodeId=f1291e9383555, content=<a href='/topic/show?id=5a3f1621e7d' target=_blank style='color:#2F92EE;'>#SGLT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16217, encryptionId=5a3f1621e7d, topicName=SGLT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Tue Sep 01 15:59:00 CST 2020, time=2020-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1852185, encodeId=595f1852185a6, content=<a href='/topic/show?id=f0a254918f0' target=_blank style='color:#2F92EE;'>#抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Tue Aug 25 04:59:00 CST 2020, time=2020-08-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1835844, encodeId=cfd518358449f, content=<a href='/topic/show?id=cfdc22e893f' target=_blank style='color:#2F92EE;'>#临床应用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22789, encryptionId=cfdc22e893f, topicName=临床应用)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fc8528, createdName=clmlylxy, createdTime=Wed Sep 23 05:59:00 CST 2020, time=2020-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1995577, encodeId=9db019955e7db, content=<a href='/topic/show?id=992411149e' target=_blank style='color:#2F92EE;'>#2抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1114, encryptionId=992411149e, topicName=2抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28b7142, createdName=liuquan, createdTime=Wed Sep 30 06:59:00 CST 2020, time=2020-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1377636, encodeId=892713e763673, content=<a href='/topic/show?id=5dfe4420fc' target=_blank style='color:#2F92EE;'>#CDS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4420, encryptionId=5dfe4420fc, topicName=CDS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ec25412, createdName=yangpeizhi, createdTime=Sun Nov 24 09:59:00 CST 2019, time=2019-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1503794, encodeId=4bbe1503e9457, content=<a href='/topic/show?id=60b916226e1' target=_blank style='color:#2F92EE;'>#SGLT2#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16226, encryptionId=60b916226e1, topicName=SGLT2)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3afa9693555, createdName=jiekemin, createdTime=Sun Nov 24 09:59:00 CST 2019, time=2019-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=375663, encodeId=41fb3e5663e9, content=应该不错,不过泌尿系统感染仍不能忽视, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Fri Nov 22 19:59:29 CST 2019, time=2019-11-22, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1793835, encodeId=f1291e9383555, content=<a href='/topic/show?id=5a3f1621e7d' target=_blank style='color:#2F92EE;'>#SGLT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16217, encryptionId=5a3f1621e7d, topicName=SGLT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Tue Sep 01 15:59:00 CST 2020, time=2020-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1852185, encodeId=595f1852185a6, content=<a href='/topic/show?id=f0a254918f0' target=_blank style='color:#2F92EE;'>#抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Tue Aug 25 04:59:00 CST 2020, time=2020-08-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1835844, encodeId=cfd518358449f, content=<a href='/topic/show?id=cfdc22e893f' target=_blank style='color:#2F92EE;'>#临床应用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22789, encryptionId=cfdc22e893f, topicName=临床应用)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fc8528, createdName=clmlylxy, createdTime=Wed Sep 23 05:59:00 CST 2020, time=2020-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1995577, encodeId=9db019955e7db, content=<a href='/topic/show?id=992411149e' target=_blank style='color:#2F92EE;'>#2抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1114, encryptionId=992411149e, topicName=2抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28b7142, createdName=liuquan, createdTime=Wed Sep 30 06:59:00 CST 2020, time=2020-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1377636, encodeId=892713e763673, content=<a href='/topic/show?id=5dfe4420fc' target=_blank style='color:#2F92EE;'>#CDS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4420, encryptionId=5dfe4420fc, topicName=CDS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ec25412, createdName=yangpeizhi, createdTime=Sun Nov 24 09:59:00 CST 2019, time=2019-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1503794, encodeId=4bbe1503e9457, content=<a href='/topic/show?id=60b916226e1' target=_blank style='color:#2F92EE;'>#SGLT2#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16226, encryptionId=60b916226e1, topicName=SGLT2)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3afa9693555, createdName=jiekemin, createdTime=Sun Nov 24 09:59:00 CST 2019, time=2019-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=375663, encodeId=41fb3e5663e9, content=应该不错,不过泌尿系统感染仍不能忽视, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Fri Nov 22 19:59:29 CST 2019, time=2019-11-22, status=1, ipAttribution=)]
    2019-11-24 yangpeizhi
  6. [GetPortalCommentsPageByObjectIdResponse(id=1793835, encodeId=f1291e9383555, content=<a href='/topic/show?id=5a3f1621e7d' target=_blank style='color:#2F92EE;'>#SGLT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16217, encryptionId=5a3f1621e7d, topicName=SGLT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Tue Sep 01 15:59:00 CST 2020, time=2020-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1852185, encodeId=595f1852185a6, content=<a href='/topic/show?id=f0a254918f0' target=_blank style='color:#2F92EE;'>#抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Tue Aug 25 04:59:00 CST 2020, time=2020-08-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1835844, encodeId=cfd518358449f, content=<a href='/topic/show?id=cfdc22e893f' target=_blank style='color:#2F92EE;'>#临床应用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22789, encryptionId=cfdc22e893f, topicName=临床应用)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fc8528, createdName=clmlylxy, createdTime=Wed Sep 23 05:59:00 CST 2020, time=2020-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1995577, encodeId=9db019955e7db, content=<a href='/topic/show?id=992411149e' target=_blank style='color:#2F92EE;'>#2抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1114, encryptionId=992411149e, topicName=2抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28b7142, createdName=liuquan, createdTime=Wed Sep 30 06:59:00 CST 2020, time=2020-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1377636, encodeId=892713e763673, content=<a href='/topic/show?id=5dfe4420fc' target=_blank style='color:#2F92EE;'>#CDS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4420, encryptionId=5dfe4420fc, topicName=CDS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ec25412, createdName=yangpeizhi, createdTime=Sun Nov 24 09:59:00 CST 2019, time=2019-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1503794, encodeId=4bbe1503e9457, content=<a href='/topic/show?id=60b916226e1' target=_blank style='color:#2F92EE;'>#SGLT2#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16226, encryptionId=60b916226e1, topicName=SGLT2)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3afa9693555, createdName=jiekemin, createdTime=Sun Nov 24 09:59:00 CST 2019, time=2019-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=375663, encodeId=41fb3e5663e9, content=应该不错,不过泌尿系统感染仍不能忽视, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Fri Nov 22 19:59:29 CST 2019, time=2019-11-22, status=1, ipAttribution=)]
    2019-11-24 jiekemin
  7. [GetPortalCommentsPageByObjectIdResponse(id=1793835, encodeId=f1291e9383555, content=<a href='/topic/show?id=5a3f1621e7d' target=_blank style='color:#2F92EE;'>#SGLT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16217, encryptionId=5a3f1621e7d, topicName=SGLT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Tue Sep 01 15:59:00 CST 2020, time=2020-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1852185, encodeId=595f1852185a6, content=<a href='/topic/show?id=f0a254918f0' target=_blank style='color:#2F92EE;'>#抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Tue Aug 25 04:59:00 CST 2020, time=2020-08-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1835844, encodeId=cfd518358449f, content=<a href='/topic/show?id=cfdc22e893f' target=_blank style='color:#2F92EE;'>#临床应用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22789, encryptionId=cfdc22e893f, topicName=临床应用)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fc8528, createdName=clmlylxy, createdTime=Wed Sep 23 05:59:00 CST 2020, time=2020-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1995577, encodeId=9db019955e7db, content=<a href='/topic/show?id=992411149e' target=_blank style='color:#2F92EE;'>#2抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1114, encryptionId=992411149e, topicName=2抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28b7142, createdName=liuquan, createdTime=Wed Sep 30 06:59:00 CST 2020, time=2020-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1377636, encodeId=892713e763673, content=<a href='/topic/show?id=5dfe4420fc' target=_blank style='color:#2F92EE;'>#CDS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4420, encryptionId=5dfe4420fc, topicName=CDS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ec25412, createdName=yangpeizhi, createdTime=Sun Nov 24 09:59:00 CST 2019, time=2019-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1503794, encodeId=4bbe1503e9457, content=<a href='/topic/show?id=60b916226e1' target=_blank style='color:#2F92EE;'>#SGLT2#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16226, encryptionId=60b916226e1, topicName=SGLT2)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3afa9693555, createdName=jiekemin, createdTime=Sun Nov 24 09:59:00 CST 2019, time=2019-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=375663, encodeId=41fb3e5663e9, content=应该不错,不过泌尿系统感染仍不能忽视, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Fri Nov 22 19:59:29 CST 2019, time=2019-11-22, status=1, ipAttribution=)]
    2019-11-22 lovetcm

    应该不错,不过泌尿系统感染仍不能忽视

    0

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