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近期2型糖尿病研究精华一览

2017-02-18 MedSci MedSci原创

世界人口中2型糖尿病平均患病率为2%~6%,其中儿童2型糖尿病占所有2型糖尿病的1%~2%。肥胖、高热量饮食、体力活动不足、高血压、血脂异常等因素是2型糖尿病的主要致病原因。本文小编为大家整理了1月以来2型糖尿病突破性进展,梅斯医学小编为您一一盘点。【1】Diabetes Care:老年2型糖尿病患者西他列汀安全性评估 关于老年2型糖尿病患者降糖药物的疗效和安全性评估只要少量的研究数

世界人口中2型糖尿病平均患病率为2%~6%,其中儿童2型糖尿病占所有2型糖尿病的1%~2%。肥胖、高热量饮食、体力活动不足、高血压、血脂异常等因素是2型糖尿病的主要致病原因。本文小编为大家整理了1月以来2型糖尿病突破性进展,梅斯医学小编为您一一盘点。


关于老年2型糖尿病患者降糖药物的疗效和安全性评估只要少量的研究数据。评估西他列汀的心血管结局的临床试验(TECOS)是一个随机、双盲、安慰剂对照的试验,该研究旨在评估西他列汀对2型糖尿病(HbA1c≥6.5%[48mmol/mol]和≤8%[64mmol/mol])与心血管疾病患者心血管死亡、非致死性卒中、非致死性心肌梗死或不稳定型心绞痛而住院的主要复合结局的影响,研究者分析了TECOS研究中年龄超过75年参与者的基线特征和临床预后。该研究结果于近日发表在糖尿病领域权威杂志Diabetes Care上。

研究人员总结了老年与年轻的参与者和治疗组内老年人队列的临床和安全事件。

该研究中有14,351名参与者记录了年龄,2004名(14%)参与者≥75岁(平均年龄78.3岁[SD为3.1]),68%为男性,2型糖尿病平均病程为12年(四分卫间距为7-21)。在中位随访时间为2.9年的随访期间,老年参与者的主要结局(6.46 vs. 3.67次事件每100人每年;危险比为1.72 [95%可信区间为1.52-1.94 ])、死亡(危险比为2.52[95%可信区间为2.20-2.89])、严重低血糖(危险比为1.53 [95%可信区间为1.15-2.03 ]),骨折(危险比为1.84[95%可信区间为1.84-2.35 ])的发生率较高。在老年人队列中,西他列汀对主要复合结局(1.10[0.89-1.36])、死亡(1.05[0.83-1.32])、心衰住院(0.99[0.65-1.49])、严重的低血糖(1.03[0.62-1.71])、急性胰腺炎和胰腺癌的发生率或严重不良事件没有显著影响。

由此可见,对于控制良好的2型糖尿病和心血管疾病老年患者,西他列汀对心血管风险无显著的影响并不会引起重大的安全问题。


近日,糖尿病领域权威杂志Diabetes Care发表了一篇研究文章,这项研究旨在明确过量的死亡率风险与2型糖尿病伴发的抑郁和/或焦虑症状相关。

研究人员使用来自于Nord-Trøndelag健康研究(HUNT 2)的64177名挪威人的数据,该研究与挪威死亡原因登记中心相联系。研究人员评估了在1995年至2013年期间参与调查人群的全因死亡率。研究者使用Cox比例风险模型评估了18岁以上与2型糖尿病相关的死亡率风险,以及对基线水平存在的伴发情感症状进行评估。

在该研究结果中,研究人员得出三中清晰的模式,首先,糖尿病患者在存在抑郁症或焦虑,或两者均有的情况下,死亡率风险明显增加。其次,伴有焦虑症状的患者死亡率风险最低,共患有抑郁和焦虑的患者死亡率风险较高,抑郁症患者死亡率风险最高。最后,与抑郁症和焦虑相关的过量死亡风险在男性糖尿病患者中可以观察到,而在女性中没有观察到。在只有抑郁症症状的男性糖尿病患者中死亡的风险最高(风险比为3.47,95%可信区间为1.96-6.14)。

该研究提供的证据表明,焦虑症状可以独立于抑郁症症状,除了减弱抑郁症状和这些个体死亡率之间相关性的抑郁症症状外,影响2型糖尿病患者的死亡率风险。

【3】BMJ:预防2型糖尿病筛查和治疗策略的诊断准确性和有效性评价 

最近,顶级杂志BMJ上发表了一篇研究文章,旨在评估糖尿病前期患者糖尿病前期筛查试验的诊断准确性和预防2型糖尿病发病的干预措施(生活方式或二甲双胍)的疗效。

研究人员共浏览了2874篇文献,对148篇论文(涵盖了138项研究)进行了全面的审查。最后分析纳入了49个筛查试验(其中5个是患病率的研究)和50个干预试验的研究。尽管不同的研究采用了不同的临界值,对于糖尿病前期的筛查,糖化血蛋白(HbA1c)的平均灵敏度为0.49(95%可信区间为0.40-0.58),特异性为0.79(0.73-0.84)。空腹血糖的平均敏感性为0.25(0.19-0.32)和特异性为0.94(0.92-0.96)。不同的血糖异常指标识别不同的亚群(例如,47%的HbA1c异常患者,其他血糖指标没有异常)。从六个月至六年,生活方式干预可以减少36%(28%-43%)的2型糖尿病的相对风险,在后续的随访中衰减到20%(8%-31%)。

由此可见,HbA1c对于糖尿病前期的筛查既不敏感,也不特异;空腹血糖较为特异但不敏感。对通过筛查确定的糖尿病前期患者进行干预措施可以预防或延缓试验人群中2型糖尿病发病。由于筛查不够准确,许多人会被误诊导致不需要进行干预的人接受干预,而真正需要干预的人反而未接受干预。这些研究结果表明,单独实施“筛查和治疗”的策略不太可能对大量发病2型糖尿病有重大影响。


近日,糖尿病领域权威杂志Diabetes Care上发表了一篇研究文章。研究人员旨在评价运用利司那肽与安慰剂对当前进行降糖治疗后血糖仍然控制不佳的老年2型糖尿病患者血糖控制疗效和安全性比较。

在这个II期、双盲、随机化、安慰剂对照、设立平行组的两队列多中心临床试验中,年龄超过70岁的患者随机分组,在早餐前分别接受每日一次的利司那肽20μg或安慰剂以及他们现有的降糖治疗药物(包括胰岛素)治疗24周。存在营养不良或中度至重度认知功能障碍风险的患者被排除。该研究的主要终点是从基线到治疗24周后HbA1c的绝对变化值。次要终点包括从基线至治疗24周后2小时餐后血糖(PPG)和体重的变化情况。

该研究共有350例患者进行随机化分组。从基线到治疗24周后利司那肽治疗组的患者HbA1c大幅下降(0.57% [6.2mmol/mol])与安慰剂相比(0.06% [0.7mmol/mol])(P<0.0001)。2小时PPG降低的平均值在利司那肽治疗组更加显著(−5.12mmol/L)相比于安慰剂治疗组(−0.07mmol/L;P<0.0001)。在利司那肽治疗组的患者体重明显下降(−1.47kg)与安慰剂(−0.16kg;P<0.0001)相比。在这个老年人群中利司那肽的安全谱,包括恶心、呕吐的发生率,与其他利司那肽研究所观察的一致。在利司那肽治疗组低血糖的报告发生率为17.6%,而在安慰剂组为10.3%。

在当前进行降糖治疗后血糖仍然控制不佳的非脆弱的老年患者中,在降低HbA1c和餐后高血糖方面,利司那肽优于安慰剂,并且没有出现意外的安全问题。


近日,糖尿病领域权威杂志Diabetes Care发表了一篇研究文章,这项Qatar 研究主要是为了探究艾塞那肽加上吡格列酮进行联合治疗与基础胰岛素治疗对经二甲双胍加磺脲类降糖药治疗后血糖长期控制不佳的2型糖尿病患者的疗效并进行比较。

研究结果曾在去年美国新奥尔良ADA年会上公布。艾塞那肽可改善β细胞功能,而噻唑烷二酮类药物吡格列酮可改善β细胞功能和胰岛素敏感性。两药联合可以改善2型糖尿病患者的代谢缺陷。

研究人员将231例血糖控制不佳的2型糖尿病患者随机分配至每周2mg缓释艾塞那肽注射液联合每天15mg口服吡格列酮或早餐甘精胰岛素联合每餐前给予4-6单位门冬胰岛素治疗组。

6个月后,药物联合治疗组HbA1c平均水平(降至6.7%)和胰岛素治疗组(降至7.4%)HbA1c平均水平差异显著(P<0.0001)。12个月后,两组相差0.9%,18个月后相差1%(P<0.0001)。

药物联合治疗组相较于胰岛素治疗组达到ADA指南HbA1c <7.0%治疗目标的参与者比例更高(83% vs 53%,P=0.003),且药物联合治疗组达到HbA1c<6.5%的参与者比例也更高(50% vs 13%,P<0.0001)。


近日,神经病学领域权威取杂志Neurology上发表了一篇研究文章,研究人员旨在评估空腹血糖(FPG)的变异性,通过测得的变异系数(CV)来衡量,能否作为糖尿病性多发性神经病(DPN)的风险预测因子,考虑到糖化血红蛋白(HbA1c)和其他传统的危险因素。

研究人员以参加全国糖尿病护理管理计划且年龄大于30岁无DPN的2型糖尿病患者(n=36152)为基础。这些参与者在2002年-2004年期间被招募入研究,并一直监测到2011年。研究人员采用Cox比例风险回归模型分析相关的因素。

在平均随访时间为7.23年的随访中,共有7219例参与者发生DPN被确定,其粗略发生率为27.62人/每1000人每年(男性为25.83人和女性为29.31人)。多因素调整后,FPG-CV和HbA1c可以作为DPN的显著预测因子,FPG-CV第四到第五百分位数其相应的风险比为1.14(95%可信区间为1.05–1.23)和1.15(95%可信区间为1.06–1.24),而对于HbA1c≥7%的风险比为1.13(95%可信区间为1.07–1.20)。在排除在敏感性分析中潜在的混杂因素后,这一发现仍然保持一致,进一步验证了研究结果。

由此可见,FPG-CV和HbA1c≥7%是2型糖尿病患者发生DPN的有效预测因子。在HbA1c、血糖变异性和DPN之间的相关性表明存在联系的病理生理学机制,其在临床风险评估中发挥了至关重要的作用。


近日,肾脏病领域权威杂志kidney international上发表了一篇研究文章,研究人员在Steno-2研究的事后分析中,分析了强化的综合治疗对2型糖尿病合并微量白蛋白尿患者肾脏功能预后的影响。

该研究的结局指标进展为大量蛋白尿、肾小球滤过率(GFR)下降和导致发展成终末期肾脏疾病。总的来说,160例被招募的2型糖尿病合并微量白蛋白尿的患者被随机分组,分别接受常规治疗或针对多种危险因素的强化治疗。

平均干预的持续时间为7.8年,此后所有患者均给予强化治疗其总随访时间长达21年,来监测蛋白尿、肾小球滤过率、终末期肾病和死亡。研究人员发现在强化治疗组进展为大量蛋白尿的患者显著减少其风险比为0.48[95%可信区间为0.31-0.84]。相比于常规治疗组为4.0ml/min/年,强化治疗组患者GFR下降为3.1ml/min/年,并且有显著差异。强化治疗组患者进展为终末期肾脏疾病趋势的调整后风险比为0.36 [0.12-1.05]。终末期肾病合并死亡其风险比明显降低为0.53 [0.35-0.8]。

因此,强化综合治疗可以延缓肾病和肾功能丧失的进展情况,降低终末期肾脏疾病的风险。


目前,全球有4.15亿人患有糖尿病,此外,尚有约1.93亿糖尿病人没有被诊断为糖尿病。

2型糖尿病占糖尿病患者的90%以上,它可以导致微血管和大血管等一些列并发症,这对患者和护理者造成沉重的心理和身体痛苦,并对保健系统造成巨大负担。

尽管对2型糖尿病的相关风险因素有了更多的了解和认识,并制定了成功的预防计划,但是在全球范围,该疾病的发病率和流行率仍然继续上升。

通过临床筛查和可用的安全有效的治疗及早期检测,可以通过早期预防或者延迟并发症从而降低发病率和死亡率。

增加对特定糖尿病表型和基因型的理解和认识可能有助于对2型糖尿病患者做出更具体和个性化的管理方案。


1月30日的《糖尿病》(Diabetes)杂志上的一项研究显示:生活在空气污染水平较高的拉丁裔儿童患2型糖尿病的风险更高,这是首次在儿童身上发现空气污染(ambient air pollution)与糖尿病风险之间的关系。

从2001年到2012年长达12年的时间里,加利福尼亚洛杉矶的大部分儿童参与了美国国立卫生研究院(NIH)资助的拉丁裔青少年患2型糖尿病的风险研究(SOLAR)的项目。科学家对其中登注册的314名8到15岁的肥胖儿童的健康状况和各自住宅空气污染进行了长达3.5年的跟踪,他们在登记时未患2型糖尿病。

结果发现:当孩子18岁时,他们的胰岛素细胞比正常人低13%,由于细胞不能有效分泌胰岛素,血液中的糖调节使系统不堪重负,增加了2型糖尿病的风险。

文章的通讯作者、南加州大学和Keck医学院的糖尿病和肥胖症研究所的副主任Michael Goran表示,长期暴露于有害空气污染儿童的肥胖风险和2型糖尿病风险显着提高。空气质量差似乎是儿童肥胖和糖尿病的催化剂,但可能是通过不同的途径导致。长期暴露于不健康空气,会导致体内的β细胞(分泌胰岛素的特殊胰腺细胞,维持血液中适当的糖水平)的功能被过度使用最终被破坏。

文章的一作、Keck医学院的预防医学教授Frank Gilliland表示,糖尿病是美国等发达国家较为流行的疾病,由于久坐的寿命和高热量饮食导致的肥胖会增加糖尿病。此外,空气污染也提高了2型糖尿病的发病风险。


来自美国医师学会最近更新的一项指南再次明确,二甲双胍是治疗2型糖尿病的一线药物,而其它多种新型药物只有在被需要的时候才会添加到2型糖尿病的治疗药物中去。美国家庭医生学会对该指南表示了认可,由于近年来很多研究者对糖尿病药物进行了深入的研究,以及FDA批准了很多新型的糖尿病药物,所以美国医师协会对糖尿病的药物治疗指南进行了更新。

美国医师学会主席Nitin Damle在一次大学新闻发布会上表示,二甲双胍,除非禁忌,否则其就是一种有效的疗法,因为其治疗效率较高,而且相应的副作用较小,相比其它口服药物而言,二甲双胍的价格低廉。在美国,肥胖率的增加往往会从本质上增加糖尿病的发生率和流行率,而药物二甲双胍的另外一个好处就是其能够降低个体的体重。

美国医师学会推荐,如果患者需要口服第二种药物来降低血糖水平的话,那么就应该增加药物磺酰脲、噻唑烷二酮、SGLT-2抑制剂或者DPP-4抑制剂。磺酰脲药物包括格列本脲、格列美脲、格列吡嗪和甲苯磺丁脲,噻唑烷二酮药物包括吡格列酮和罗格列酮。

SGLT-2抑制剂则包括坎格列净、依帕列净和达格列净;DPP-4抑制剂包括西他列汀或利拉利汀;而二甲双胍的商标名包括格华止、Glumetza和Fortamet。研究者Damle表示,向二甲双胍疗法中添加第二种药物或许能够带来额外的治疗效益。然而,药物价格的增加往往并不总是会支持额外的好处,尤其是一些价格高昂的新型药物,美国医师协会认为临床医生和患者应当讨论药物的疗效、副作用以及额外附加药物的价值。

据美国CDC数据显示,目前在美国大约有2900万糖尿病患者,患者日常的治疗开支非常大,因此研究者们也希望通过后期更为深入的研究来寻找到能够有效预防和治疗糖尿病的新型疗法。本文研究结果刊登于国际杂志the Annals of Internal Medicine上。

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  1. [GetPortalCommentsPageByObjectIdResponse(id=178307, encodeId=55e71e83076e, content=休息休息吃饭了吗, 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/20170126/IMG588939F5DDB338350.jpg, createdBy=b3812014266, createdName=琵琶枇杷, createdTime=Wed Mar 01 07:34:25 CST 2017, time=2017-03-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=178062, encodeId=69791e806279, content=惺惺惜惺惺下, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20170126/IMG588939F5DDB338350.jpg, createdBy=b3812014266, createdName=琵琶枇杷, createdTime=Mon Feb 27 08:43:01 CST 2017, time=2017-02-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=177910, encodeId=1ac71e791062, content=粽粽粽粽粽粽粽在, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20170126/IMG588939F5DDB338350.jpg, createdBy=b3812014266, createdName=琵琶枇杷, createdTime=Sun Feb 26 07:47:19 CST 2017, time=2017-02-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=177814, encodeId=a17c1e7814b2, content=CC许多人让他, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20170126/IMG588939F5DDB338350.jpg, createdBy=b3812014266, createdName=琵琶枇杷, createdTime=Sat Feb 25 07:40:42 CST 2017, time=2017-02-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=177443, encodeId=0d0b1e74431d, content=文章很不错哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, 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 Feb 22 14:22:17 CST 2017, time=2017-02-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=177374, encodeId=2bfc1e7374a3, content=惺惺惜惺惺下, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20170126/IMG588939F5DDB338350.jpg, createdBy=b3812014266, createdName=琵琶枇杷, createdTime=Wed Feb 22 07:49:52 CST 2017, time=2017-02-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=177243, encodeId=c80e1e7243e6, content=文章真心不错耶, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, 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=Tue Feb 21 09:11:58 CST 2017, time=2017-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=177039, encodeId=44261e7039d6, content=不错,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=20022010087, createdName=1e1e9fabm77(暂无匿称), createdTime=Mon Feb 20 00:30:14 CST 2017, time=2017-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176983, encodeId=7f861e698398, content=好好努力, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Feb 19 15:03:23 CST 2017, time=2017-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176913, encodeId=593d1e691344, content=儿童2型糖尿病比例相对较少。, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Sun Feb 19 08:08:34 CST 2017, time=2017-02-19, status=1, ipAttribution=)]
    2017-03-01 琵琶枇杷

    休息休息吃饭了吗

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=178307, encodeId=55e71e83076e, content=休息休息吃饭了吗, 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/20170126/IMG588939F5DDB338350.jpg, createdBy=b3812014266, createdName=琵琶枇杷, createdTime=Wed Mar 01 07:34:25 CST 2017, time=2017-03-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=178062, encodeId=69791e806279, content=惺惺惜惺惺下, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20170126/IMG588939F5DDB338350.jpg, createdBy=b3812014266, createdName=琵琶枇杷, createdTime=Mon Feb 27 08:43:01 CST 2017, time=2017-02-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=177910, encodeId=1ac71e791062, content=粽粽粽粽粽粽粽在, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20170126/IMG588939F5DDB338350.jpg, createdBy=b3812014266, createdName=琵琶枇杷, createdTime=Sun Feb 26 07:47:19 CST 2017, time=2017-02-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=177814, encodeId=a17c1e7814b2, content=CC许多人让他, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20170126/IMG588939F5DDB338350.jpg, createdBy=b3812014266, createdName=琵琶枇杷, createdTime=Sat Feb 25 07:40:42 CST 2017, time=2017-02-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=177443, encodeId=0d0b1e74431d, content=文章很不错哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, 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 Feb 22 14:22:17 CST 2017, time=2017-02-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=177374, encodeId=2bfc1e7374a3, content=惺惺惜惺惺下, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20170126/IMG588939F5DDB338350.jpg, createdBy=b3812014266, createdName=琵琶枇杷, createdTime=Wed Feb 22 07:49:52 CST 2017, time=2017-02-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=177243, encodeId=c80e1e7243e6, content=文章真心不错耶, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, 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=Tue Feb 21 09:11:58 CST 2017, time=2017-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=177039, encodeId=44261e7039d6, content=不错,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=20022010087, createdName=1e1e9fabm77(暂无匿称), createdTime=Mon Feb 20 00:30:14 CST 2017, time=2017-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176983, encodeId=7f861e698398, content=好好努力, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Feb 19 15:03:23 CST 2017, time=2017-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176913, encodeId=593d1e691344, content=儿童2型糖尿病比例相对较少。, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Sun Feb 19 08:08:34 CST 2017, time=2017-02-19, status=1, ipAttribution=)]
    2017-02-27 琵琶枇杷

    惺惺惜惺惺下

    0

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    2017-02-26 琵琶枇杷

    粽粽粽粽粽粽粽在

    0

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    2017-02-25 琵琶枇杷

    CC许多人让他

    0

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    2017-02-22 1e10c84am36(暂无匿称)

    文章很不错哦

    0

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    2017-02-22 琵琶枇杷

    惺惺惜惺惺下

    0

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    2017-02-21 1e10c84am36(暂无匿称)

    文章真心不错耶

    0

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    2017-02-20 1e1e9fabm77(暂无匿称)

    不错,学习了

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=178307, encodeId=55e71e83076e, content=休息休息吃饭了吗, 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/20170126/IMG588939F5DDB338350.jpg, createdBy=b3812014266, createdName=琵琶枇杷, createdTime=Wed Mar 01 07:34:25 CST 2017, time=2017-03-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=178062, encodeId=69791e806279, content=惺惺惜惺惺下, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20170126/IMG588939F5DDB338350.jpg, createdBy=b3812014266, createdName=琵琶枇杷, createdTime=Mon Feb 27 08:43:01 CST 2017, time=2017-02-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=177910, encodeId=1ac71e791062, content=粽粽粽粽粽粽粽在, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20170126/IMG588939F5DDB338350.jpg, createdBy=b3812014266, createdName=琵琶枇杷, createdTime=Sun Feb 26 07:47:19 CST 2017, time=2017-02-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=177814, encodeId=a17c1e7814b2, content=CC许多人让他, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20170126/IMG588939F5DDB338350.jpg, createdBy=b3812014266, createdName=琵琶枇杷, createdTime=Sat Feb 25 07:40:42 CST 2017, time=2017-02-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=177443, encodeId=0d0b1e74431d, content=文章很不错哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, 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 Feb 22 14:22:17 CST 2017, time=2017-02-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=177374, encodeId=2bfc1e7374a3, content=惺惺惜惺惺下, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20170126/IMG588939F5DDB338350.jpg, createdBy=b3812014266, createdName=琵琶枇杷, createdTime=Wed Feb 22 07:49:52 CST 2017, time=2017-02-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=177243, encodeId=c80e1e7243e6, content=文章真心不错耶, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, 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=Tue Feb 21 09:11:58 CST 2017, time=2017-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=177039, encodeId=44261e7039d6, content=不错,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=20022010087, createdName=1e1e9fabm77(暂无匿称), createdTime=Mon Feb 20 00:30:14 CST 2017, time=2017-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176983, encodeId=7f861e698398, content=好好努力, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Feb 19 15:03:23 CST 2017, time=2017-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=176913, encodeId=593d1e691344, content=儿童2型糖尿病比例相对较少。, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Sun Feb 19 08:08:34 CST 2017, time=2017-02-19, status=1, ipAttribution=)]
    2017-02-19 忠诚向上

    好好努力

    0

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    2017-02-19 邓启付

    儿童2型糖尿病比例相对较少。

    0

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