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留置导尿 2 个月,尿液竟突然变成紫色,这个案例,你一定得知道!!

2019-01-27 佚名 医学界急诊与重症频道

留置导尿 2 个月,尿液竟突然变成紫色,这个案例,你一定得知道!!

提起 PUBS,大家肯定会跟我一样脑海里首先浮现出那个繁华喧嚣的酒吧:朦胧的夜色,灯红酒绿的房间,耳朵里充斥着各种蠢蠢欲动的音乐,精力旺盛的年轻人,摇晃的高脚杯,各种花式调酒的精彩表演,放纵 or 艳遇的代名词……然而今天给大家介绍的 PUBS 并不是一家酒吧,而是 Purple Urine Bag Syndrome,紫色尿袋综合征。

病史简介

患者,女,80 岁,脑卒中后遗症,近 2 月来开始卧床,本次因留置导尿管 2 个月尿液突然变为紫色(如下图)来院:

查体无明显阳性发现。实验室检查:白细胞 13.9 × 109 /L,红细胞 4.72 × 1012/L,血小板 208 × 109 /L,超敏 C 反应蛋白:75 mg/l;急诊生化:GLU:7.37 mmol/l,BUN:7.7 mmol/L,Cr:101 μmol/L;尿常规如下:

全腹部 CT 可见膀胱内异常高密度影(如下图):

患者经更换尿管及尿袋后尿色正常(如下图):

虚惊一场后我们开始查找相关文献,原来这是一例罕见的紫色尿袋综合征!这种综合征最有趣的一点是尿液本身并不是紫色的,但在接触尿袋后会在尿袋表面呈现紫色!那么问题来了:

PUBS的危险因素有哪些?

包括长期留置导尿、老年女性、脱水、长期卧床、便秘、晚期的慢性肾脏疾病、碱性或酸性尿液、PVC(聚氯乙烯)材质的尿管和尿袋等。

想了解 PUBS 历史的往下翻

最早在 1978 年由 Barlow 和 Dickson 在《柳叶刀》上报道了紫色的尿液,文章分析肠道色氨酸经降解后生成硫酸吲哚酚,并通过光谱分析证实了吲哚为靛蓝色;随后,Sammons HG 等学者质疑尿液的颜色,认为靛蓝主要是蓝色着色,并提出假设,认为只有尿液接触尿袋后才会变成紫色,同时与尿道中的铜绿假单胞菌和变形杆菌有关。

接着,McSherry 等研究指出尿蓝母尿(尿蓝母尿由蛋白质分解的色氨酸经肠内细菌的作用而产生靛基质,或称吲哚(Indol),它在肝脏内氧化为羟吲哚(Indoxyl),再与硫酸盐结合成为羟吲哚硫酸钾,称为尿蓝母(Indican)。尿蓝母本为家畜尿中的正常成分,但因含量不多,用化学试剂检验多呈阴性,当尿,中出现大量的尿蓝母时,称为尿蓝母尿。

临床意义尿蓝母按其来源可分为肠型尿蓝母尿和组织型尿蓝母尿两种:

① 肠型尿蓝母尿见于各种肠阻塞,肠套叠,小肠卡他及其他伴有肠内蛋白质分解旺盛的疾病。

② 组织型尿蓝母尿见于组织的崩解,如肺坏疽、子宫炎及内脏器官的脓肿等。是紫色尿液形成的原因之一;在这些最初的报道中,涉及相关综合征的都是一些患有老年痴呆症和便秘的老年妇女。

继续深挖历史,在 1990 年 Umeki 等人发现由奇异变形杆菌和肺炎克雷伯菌产生的吲哚酚磷酸酶和硫酸酯酶能催化碱性尿液中的吲哚酚硫酸转化为(蓝色) 靛蓝和靛玉红 (红色)。在此后的十年里,紫色尿袋综合征被认为是妇女和尿检呈碱性的患者存在尿路感染的高危因素之一。

那么 PUBS 一定要在碱性环境下才能形成吗?

不是的。

2006 年在《Clin Chim Acta》Bar-Or 等人报道紫尿袋综合症的发生在非碱性尿液环境中,也能出现靛蓝;

2008 年在《Nephrology (Carlton)》中的研究表明紫尿袋综合症在培养为革兰氏阴性菌尿液 (绿脓假单胞菌、枸橼酸杆菌、普罗维登斯菌、摩根氏菌和大肠杆菌)的患者中发病率占 16.7%,这一发现质疑了碱性尿液的在 PUBS 中发生的必要性。

2008 年 Chung 等在《Int J Infect Dis》杂志中也报道称发现 PUBS 在革兰氏阴性菌的酸性尿液中形成。

PUBS的发病机制

便秘或者其他因素引起细菌增生(主要是携带硫酸酯酶和/或磷酸酶酶的细菌如克雷伯氏菌、大肠杆菌、摩根氏菌属、假单胞菌、肠杆菌属、变形杆菌属等)导致食物中的色氨酸分解增强并生成大量吲哚,吲哚经肠肝循环进入肝脏后形成硫酸吲哚酚,经尿液排泄后在在接触尿袋时在尿细菌酶(硫酸酯酶和磷酸酶)的作用下产生靛蓝(蓝色)和/或其氧化产物靛玉红(红色),这些颜色混合后就成为了紫色尿液袋。

PUBS会引起死亡吗?应该怎样治疗?

2007 年《Am J Emerg Med》中首次报道 PUBS 与死亡相关。2013 年《Case Rep Infect Dis》中报道因未能及时发现该综合征引起另一个死亡案例,在该病例中,尿培养为铜绿假单胞菌及耐万古霉素肠球菌。

PUBS 多数是良性的疾病,治疗上以保守治疗为主,目前普遍认为紫色尿袋综合征是由于色氨酸摄入过多所致,因此在饮食方面,建议患者:

① 多饮水,摄取高热量、高维生素、高蛋白及低脂的食物;

② 尽量减少食用富含色氨酸的食物,如小米、牛奶、香菇、葵花子、海蟹、黑芝麻、黄豆、南瓜子、肉松、油豆腐、鸡蛋、鱼片等;

③ 根据送检尿常规结果如 PH 偏碱,则需要酸化尿液,可督促患者多食用富含维生素C的食物;

④ 多使用含膳食纤维的食物保持大便通畅;

⑤ 及时放掉紫色尿液,根据尿培养结果选择合适抗菌药物。

临床中应加强对 PUBS 的认识,紫色尿管/袋的出现本身就是一个需要引起警惕的信号,它所反映的潜在尿路感染会引起严重的后果,所以治疗 PUBS 的同时应该积极寻找病因。

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    2019-03-02 xuyong532
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    2019-03-15 jyzxjiangqin

    尿液的科学区分治疗。

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1670099, encodeId=b52a16e009951, content=<a href='/topic/show?id=809ce0322c0' target=_blank style='color:#2F92EE;'>#留置#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70322, encryptionId=809ce0322c0, topicName=留置)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=532e26580241, createdName=xuyong532, createdTime=Sat Mar 02 15:36:00 CST 2019, time=2019-03-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=362667, encodeId=a5aa36266eaf, content=尿液的科学区分治疗。, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Fri Mar 15 07:00:26 CST 2019, time=2019-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=361897, encodeId=bfde36189e96, content=非常不错的文章。, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Sun Mar 03 11:02:02 CST 2019, time=2019-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=360977, encodeId=22b43609e7a8, content=尿液稀释中的问题。, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Tue Feb 19 06:48:11 CST 2019, time=2019-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359452, encodeId=2b18359452f3, content=留置导尿的影响。, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Mon Jan 28 18:25:08 CST 2019, time=2019-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1449365, encodeId=f657144936529, content=<a href='/topic/show?id=b3e24e442bc' target=_blank style='color:#2F92EE;'>#尿液#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47442, encryptionId=b3e24e442bc, topicName=尿液)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=66095470791, createdName=zhaohui6733, createdTime=Mon Jan 28 15:36:00 CST 2019, time=2019-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359392, encodeId=28fb359392ae, content=很好 见识了, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2019/01/02/f667a67c6692f1e356c51a346d5b382f.jpg, createdBy=7b7a2515105, createdName=Janeinair, createdTime=Sun Jan 27 23:38:16 CST 2019, time=2019-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359368, encodeId=c1a83593685a, content=感谢小编为我们准备了如此丰盛的精神大餐,同时也向作者致谢!认真学习了,点赞!, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30251637888, createdName=lietome15, createdTime=Sun Jan 27 11:24:58 CST 2019, time=2019-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359360, encodeId=846f3593601c, content=学习尿液检查知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160718/IMG578C993D395567540.jpg, createdBy=59b81918946, createdName=flysky120, createdTime=Sun Jan 27 10:05:29 CST 2019, time=2019-01-27, status=1, ipAttribution=)]
    2019-03-03 jyzxjiangqin

    非常不错的文章。

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1670099, encodeId=b52a16e009951, content=<a href='/topic/show?id=809ce0322c0' target=_blank style='color:#2F92EE;'>#留置#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70322, encryptionId=809ce0322c0, topicName=留置)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=532e26580241, createdName=xuyong532, createdTime=Sat Mar 02 15:36:00 CST 2019, time=2019-03-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=362667, encodeId=a5aa36266eaf, content=尿液的科学区分治疗。, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Fri Mar 15 07:00:26 CST 2019, time=2019-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=361897, encodeId=bfde36189e96, content=非常不错的文章。, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Sun Mar 03 11:02:02 CST 2019, time=2019-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=360977, encodeId=22b43609e7a8, content=尿液稀释中的问题。, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Tue Feb 19 06:48:11 CST 2019, time=2019-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359452, encodeId=2b18359452f3, content=留置导尿的影响。, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Mon Jan 28 18:25:08 CST 2019, time=2019-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1449365, encodeId=f657144936529, content=<a href='/topic/show?id=b3e24e442bc' target=_blank style='color:#2F92EE;'>#尿液#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47442, encryptionId=b3e24e442bc, topicName=尿液)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=66095470791, createdName=zhaohui6733, createdTime=Mon Jan 28 15:36:00 CST 2019, time=2019-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359392, encodeId=28fb359392ae, content=很好 见识了, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2019/01/02/f667a67c6692f1e356c51a346d5b382f.jpg, createdBy=7b7a2515105, createdName=Janeinair, createdTime=Sun Jan 27 23:38:16 CST 2019, time=2019-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359368, encodeId=c1a83593685a, content=感谢小编为我们准备了如此丰盛的精神大餐,同时也向作者致谢!认真学习了,点赞!, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30251637888, createdName=lietome15, createdTime=Sun Jan 27 11:24:58 CST 2019, time=2019-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359360, encodeId=846f3593601c, content=学习尿液检查知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160718/IMG578C993D395567540.jpg, createdBy=59b81918946, createdName=flysky120, createdTime=Sun Jan 27 10:05:29 CST 2019, time=2019-01-27, status=1, ipAttribution=)]
    2019-02-19 jyzxjiangqin

    尿液稀释中的问题。

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1670099, encodeId=b52a16e009951, content=<a href='/topic/show?id=809ce0322c0' target=_blank style='color:#2F92EE;'>#留置#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70322, encryptionId=809ce0322c0, topicName=留置)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=532e26580241, createdName=xuyong532, createdTime=Sat Mar 02 15:36:00 CST 2019, time=2019-03-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=362667, encodeId=a5aa36266eaf, content=尿液的科学区分治疗。, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Fri Mar 15 07:00:26 CST 2019, time=2019-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=361897, encodeId=bfde36189e96, content=非常不错的文章。, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Sun Mar 03 11:02:02 CST 2019, time=2019-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=360977, encodeId=22b43609e7a8, content=尿液稀释中的问题。, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Tue Feb 19 06:48:11 CST 2019, time=2019-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359452, encodeId=2b18359452f3, content=留置导尿的影响。, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Mon Jan 28 18:25:08 CST 2019, time=2019-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1449365, encodeId=f657144936529, content=<a href='/topic/show?id=b3e24e442bc' target=_blank style='color:#2F92EE;'>#尿液#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47442, encryptionId=b3e24e442bc, topicName=尿液)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=66095470791, createdName=zhaohui6733, createdTime=Mon Jan 28 15:36:00 CST 2019, time=2019-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359392, encodeId=28fb359392ae, content=很好 见识了, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2019/01/02/f667a67c6692f1e356c51a346d5b382f.jpg, createdBy=7b7a2515105, createdName=Janeinair, createdTime=Sun Jan 27 23:38:16 CST 2019, time=2019-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359368, encodeId=c1a83593685a, content=感谢小编为我们准备了如此丰盛的精神大餐,同时也向作者致谢!认真学习了,点赞!, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30251637888, createdName=lietome15, createdTime=Sun Jan 27 11:24:58 CST 2019, time=2019-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359360, encodeId=846f3593601c, content=学习尿液检查知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160718/IMG578C993D395567540.jpg, createdBy=59b81918946, createdName=flysky120, createdTime=Sun Jan 27 10:05:29 CST 2019, time=2019-01-27, status=1, ipAttribution=)]
    2019-01-28 jyzxjiangqin

    留置导尿的影响。

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1670099, encodeId=b52a16e009951, content=<a href='/topic/show?id=809ce0322c0' target=_blank style='color:#2F92EE;'>#留置#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70322, encryptionId=809ce0322c0, topicName=留置)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=532e26580241, createdName=xuyong532, createdTime=Sat Mar 02 15:36:00 CST 2019, time=2019-03-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=362667, encodeId=a5aa36266eaf, content=尿液的科学区分治疗。, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Fri Mar 15 07:00:26 CST 2019, time=2019-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=361897, encodeId=bfde36189e96, content=非常不错的文章。, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Sun Mar 03 11:02:02 CST 2019, time=2019-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=360977, encodeId=22b43609e7a8, content=尿液稀释中的问题。, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Tue Feb 19 06:48:11 CST 2019, time=2019-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359452, encodeId=2b18359452f3, content=留置导尿的影响。, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Mon Jan 28 18:25:08 CST 2019, time=2019-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1449365, encodeId=f657144936529, content=<a href='/topic/show?id=b3e24e442bc' target=_blank style='color:#2F92EE;'>#尿液#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47442, encryptionId=b3e24e442bc, topicName=尿液)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=66095470791, createdName=zhaohui6733, createdTime=Mon Jan 28 15:36:00 CST 2019, time=2019-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359392, encodeId=28fb359392ae, content=很好 见识了, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2019/01/02/f667a67c6692f1e356c51a346d5b382f.jpg, createdBy=7b7a2515105, createdName=Janeinair, createdTime=Sun Jan 27 23:38:16 CST 2019, time=2019-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359368, encodeId=c1a83593685a, content=感谢小编为我们准备了如此丰盛的精神大餐,同时也向作者致谢!认真学习了,点赞!, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30251637888, createdName=lietome15, createdTime=Sun Jan 27 11:24:58 CST 2019, time=2019-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359360, encodeId=846f3593601c, content=学习尿液检查知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160718/IMG578C993D395567540.jpg, createdBy=59b81918946, createdName=flysky120, createdTime=Sun Jan 27 10:05:29 CST 2019, time=2019-01-27, status=1, ipAttribution=)]
  7. [GetPortalCommentsPageByObjectIdResponse(id=1670099, encodeId=b52a16e009951, content=<a href='/topic/show?id=809ce0322c0' target=_blank style='color:#2F92EE;'>#留置#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70322, encryptionId=809ce0322c0, topicName=留置)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=532e26580241, createdName=xuyong532, createdTime=Sat Mar 02 15:36:00 CST 2019, time=2019-03-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=362667, encodeId=a5aa36266eaf, content=尿液的科学区分治疗。, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Fri Mar 15 07:00:26 CST 2019, time=2019-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=361897, encodeId=bfde36189e96, content=非常不错的文章。, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Sun Mar 03 11:02:02 CST 2019, time=2019-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=360977, encodeId=22b43609e7a8, content=尿液稀释中的问题。, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Tue Feb 19 06:48:11 CST 2019, time=2019-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359452, encodeId=2b18359452f3, content=留置导尿的影响。, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Mon Jan 28 18:25:08 CST 2019, time=2019-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1449365, encodeId=f657144936529, content=<a href='/topic/show?id=b3e24e442bc' target=_blank style='color:#2F92EE;'>#尿液#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47442, encryptionId=b3e24e442bc, topicName=尿液)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=66095470791, createdName=zhaohui6733, createdTime=Mon Jan 28 15:36:00 CST 2019, time=2019-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359392, encodeId=28fb359392ae, content=很好 见识了, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2019/01/02/f667a67c6692f1e356c51a346d5b382f.jpg, createdBy=7b7a2515105, createdName=Janeinair, createdTime=Sun Jan 27 23:38:16 CST 2019, time=2019-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359368, encodeId=c1a83593685a, content=感谢小编为我们准备了如此丰盛的精神大餐,同时也向作者致谢!认真学习了,点赞!, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30251637888, createdName=lietome15, createdTime=Sun Jan 27 11:24:58 CST 2019, time=2019-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359360, encodeId=846f3593601c, content=学习尿液检查知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160718/IMG578C993D395567540.jpg, createdBy=59b81918946, createdName=flysky120, createdTime=Sun Jan 27 10:05:29 CST 2019, time=2019-01-27, status=1, ipAttribution=)]
    2019-01-27 Janeinair

    很好 见识了

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1670099, encodeId=b52a16e009951, content=<a href='/topic/show?id=809ce0322c0' target=_blank style='color:#2F92EE;'>#留置#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70322, encryptionId=809ce0322c0, topicName=留置)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=532e26580241, createdName=xuyong532, createdTime=Sat Mar 02 15:36:00 CST 2019, time=2019-03-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=362667, encodeId=a5aa36266eaf, content=尿液的科学区分治疗。, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Fri Mar 15 07:00:26 CST 2019, time=2019-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=361897, encodeId=bfde36189e96, content=非常不错的文章。, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Sun Mar 03 11:02:02 CST 2019, time=2019-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=360977, encodeId=22b43609e7a8, content=尿液稀释中的问题。, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Tue Feb 19 06:48:11 CST 2019, time=2019-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359452, encodeId=2b18359452f3, content=留置导尿的影响。, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Mon Jan 28 18:25:08 CST 2019, time=2019-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1449365, encodeId=f657144936529, content=<a href='/topic/show?id=b3e24e442bc' target=_blank style='color:#2F92EE;'>#尿液#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47442, encryptionId=b3e24e442bc, topicName=尿液)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=66095470791, createdName=zhaohui6733, createdTime=Mon Jan 28 15:36:00 CST 2019, time=2019-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359392, encodeId=28fb359392ae, content=很好 见识了, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2019/01/02/f667a67c6692f1e356c51a346d5b382f.jpg, createdBy=7b7a2515105, createdName=Janeinair, createdTime=Sun Jan 27 23:38:16 CST 2019, time=2019-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359368, encodeId=c1a83593685a, content=感谢小编为我们准备了如此丰盛的精神大餐,同时也向作者致谢!认真学习了,点赞!, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30251637888, createdName=lietome15, createdTime=Sun Jan 27 11:24:58 CST 2019, time=2019-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359360, encodeId=846f3593601c, content=学习尿液检查知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160718/IMG578C993D395567540.jpg, createdBy=59b81918946, createdName=flysky120, createdTime=Sun Jan 27 10:05:29 CST 2019, time=2019-01-27, status=1, ipAttribution=)]
    2019-01-27 lietome15

    感谢小编为我们准备了如此丰盛的精神大餐,同时也向作者致谢!认真学习了,点赞!

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=1670099, encodeId=b52a16e009951, content=<a href='/topic/show?id=809ce0322c0' target=_blank style='color:#2F92EE;'>#留置#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70322, encryptionId=809ce0322c0, topicName=留置)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=532e26580241, createdName=xuyong532, createdTime=Sat Mar 02 15:36:00 CST 2019, time=2019-03-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=362667, encodeId=a5aa36266eaf, content=尿液的科学区分治疗。, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Fri Mar 15 07:00:26 CST 2019, time=2019-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=361897, encodeId=bfde36189e96, content=非常不错的文章。, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Sun Mar 03 11:02:02 CST 2019, time=2019-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=360977, encodeId=22b43609e7a8, content=尿液稀释中的问题。, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Tue Feb 19 06:48:11 CST 2019, time=2019-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359452, encodeId=2b18359452f3, content=留置导尿的影响。, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Mon Jan 28 18:25:08 CST 2019, time=2019-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1449365, encodeId=f657144936529, content=<a href='/topic/show?id=b3e24e442bc' target=_blank style='color:#2F92EE;'>#尿液#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47442, encryptionId=b3e24e442bc, topicName=尿液)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=66095470791, createdName=zhaohui6733, createdTime=Mon Jan 28 15:36:00 CST 2019, time=2019-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359392, encodeId=28fb359392ae, content=很好 见识了, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2019/01/02/f667a67c6692f1e356c51a346d5b382f.jpg, createdBy=7b7a2515105, createdName=Janeinair, createdTime=Sun Jan 27 23:38:16 CST 2019, time=2019-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359368, encodeId=c1a83593685a, content=感谢小编为我们准备了如此丰盛的精神大餐,同时也向作者致谢!认真学习了,点赞!, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30251637888, createdName=lietome15, createdTime=Sun Jan 27 11:24:58 CST 2019, time=2019-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=359360, encodeId=846f3593601c, content=学习尿液检查知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160718/IMG578C993D395567540.jpg, createdBy=59b81918946, createdName=flysky120, createdTime=Sun Jan 27 10:05:29 CST 2019, time=2019-01-27, status=1, ipAttribution=)]
    2019-01-27 flysky120

    学习尿液检查知识

    0

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