JAMA子刊:小卒中合并大血管闭塞患者单纯静脉溶栓治疗的神经系统结局预测

2021-01-18 MedSci原创 MedSci原创

小卒中或轻型卒中一般定义为NIHSS评分<6分或8分的卒中类型。

卒中或轻型卒中一般定义为NIHSS评分<6分或8分的卒中类型。虽然小卒中听上去问题很“小”,实则不然。一项针对162例轻微症状的急性卒中患者的研究表明,23.5%的患者预后不佳1.3%死亡;另一项针对378例患者的类似研究表明,14.6%的患者有早期恶化;约1/3未经溶栓治疗的“轻型卒中”患者在发病90 d内不能独立生活或死亡。

因此卒中问题无小事,小卒中≠小问题≠小血管

为什么会出现这种问题呢?原因就在于有相当比例低NIHSS评分的急性缺血性卒中患者有大血管闭塞(LVO)现象。有文献报道,14.2%(54/378)的小卒中患者(NIHSS评分≤5分)合并LVO;所有急性卒中患者LVO的发生率约为20%而这些具有LVO的患者有10%左右症状轻微。

对于小卒中合并大血管闭塞(LVO)卒中患者,再灌注的策略尚不清楚。血管内治疗在各指南或相关研究中并没有统一意见,且存在着潜在的出血并发症。那么对于此类患者,静脉溶栓后的神经功能恢复情况怎么样呢?对这类患者究竟应该如何进行治疗抉择呢?为此,国际MINOR-STROKE协作组进行了相关研究,结果发表在最新的JAMA Neurology杂志上。

专家认为,准确预测小卒中合并LVO患者静脉溶栓(IVT)后推测为缺血引起的早期神经系统恶化(ENDI)情况,可能有助于选择进行及时的血栓切除术治疗。因此,该研究旨在开发和验证一个易于适用于小卒中合并LVO患者静脉溶栓术后的ENDi预测分数。

该研究为多中心回顾性队列,其中包括729名发生过小卒中同时存在LVO(基底动脉、颈内动脉、大脑中动脉第一M1M2段)的患者。所有患者都在45个制定的法国卒中中心进行静脉溶栓治疗(IVT),其中也包括那些因ENDi而最终接受救援血栓切除术的患者。同时,从另外9个临床中心收集了347名具有类似纳入标准的患者队列。

在该研究中,专家将ENDi定义为溶栓后24小时内NIHSS评分恶化≥4分,后续影像学检查无实质出血或其他已确定原因。

结果显示,所有患者NIHSS评分的中位数为3分,闭塞部位为颈内动脉的患者有97例(13.3%),M1段与M2段闭塞的患者分别有207例(28.4%)与395例(54.2%),而基底动脉有30例(4.1%)。其中88例患者发生ENDi12.1%95%CI9.7-14.4),且此类患者即使接受了补救性血栓切除术,3个月神经功能结局较差。

多变量分析中显示,闭塞部位越靠近近端、血栓越长都与ENDi独立相关。协作组由这些变量得出一个4分评定法—1分为血栓长度,3分为闭塞部位可以对ENDi进行良好的鉴别0.7695%CI0.70-0.82)。随后该评分法在验证队列中进行了成功验证(ENDi=11.0%0.7895%CI0.70-0.86)。

综上,该研究发现ENDi率正好解释了目前关于是否直接将小卒中合并LVO患者进行IVT治疗的争论。而本文提出的评定法可有效对ENDi风险进行预测,从而协助临床医生进行上述决策制定。

 

参考文献:

Seners P, et al. Prediction of Early Neurological Deterioration in Individuals With Minor Stroke and Large Vessel Occlusion Intended for Intravenous Thrombolysis Alone. JAMA Neurol. 2021 Jan 11. doi: 10.1001/jamaneurol.2020.4557.

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (8)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1706164, encodeId=8ddf1e06164f7, content=<a href='/topic/show?id=7f6443986ec' target=_blank style='color:#2F92EE;'>#大血管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43986, encryptionId=7f6443986ec, topicName=大血管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=caff31165455, createdName=kkunny, createdTime=Mon Jan 03 13:24:27 CST 2022, time=2022-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2009870, encodeId=277020098e0b8, content=<a href='/topic/show?id=467789803a9' target=_blank style='color:#2F92EE;'>#血管闭塞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89803, encryptionId=467789803a9, topicName=血管闭塞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=827b160, createdName=cnxcy, createdTime=Wed Oct 13 20:24:27 CST 2021, time=2021-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1698188, encodeId=8cb6169818822, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Wed Nov 24 21:24:27 CST 2021, time=2021-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1283161, encodeId=a578128316112, content=<a href='/topic/show?id=4fade445192' target=_blank style='color:#2F92EE;'>#神经系统#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74451, encryptionId=4fade445192, topicName=神经系统)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=02f5179, createdName=luoxiaog, createdTime=Wed Jan 20 11:24:27 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1418590, encodeId=783e141859011, content=<a href='/topic/show?id=b88266482f7' target=_blank style='color:#2F92EE;'>#溶栓治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66482, encryptionId=b88266482f7, topicName=溶栓治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=00673387794, createdName=lqvr, createdTime=Wed Jan 20 11:24:27 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1537590, encodeId=da39153e590c8, content=<a href='/topic/show?id=221799151b3' target=_blank style='color:#2F92EE;'>#静脉溶栓治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99151, encryptionId=221799151b3, topicName=静脉溶栓治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4e9812877003, createdName=bettycmoon, createdTime=Wed Jan 20 11:24:27 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026751, encodeId=e9a71026e51c0, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Mon Jan 18 23:24:27 CST 2021, time=2021-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036403, encodeId=1f1a103640379, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Mon Jan 18 23:24:27 CST 2021, time=2021-01-18, status=1, ipAttribution=)]
    2022-01-03 kkunny
  2. [GetPortalCommentsPageByObjectIdResponse(id=1706164, encodeId=8ddf1e06164f7, content=<a href='/topic/show?id=7f6443986ec' target=_blank style='color:#2F92EE;'>#大血管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43986, encryptionId=7f6443986ec, topicName=大血管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=caff31165455, createdName=kkunny, createdTime=Mon Jan 03 13:24:27 CST 2022, time=2022-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2009870, encodeId=277020098e0b8, content=<a href='/topic/show?id=467789803a9' target=_blank style='color:#2F92EE;'>#血管闭塞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89803, encryptionId=467789803a9, topicName=血管闭塞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=827b160, createdName=cnxcy, createdTime=Wed Oct 13 20:24:27 CST 2021, time=2021-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1698188, encodeId=8cb6169818822, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Wed Nov 24 21:24:27 CST 2021, time=2021-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1283161, encodeId=a578128316112, content=<a href='/topic/show?id=4fade445192' target=_blank style='color:#2F92EE;'>#神经系统#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74451, encryptionId=4fade445192, topicName=神经系统)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=02f5179, createdName=luoxiaog, createdTime=Wed Jan 20 11:24:27 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1418590, encodeId=783e141859011, content=<a href='/topic/show?id=b88266482f7' target=_blank style='color:#2F92EE;'>#溶栓治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66482, encryptionId=b88266482f7, topicName=溶栓治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=00673387794, createdName=lqvr, createdTime=Wed Jan 20 11:24:27 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1537590, encodeId=da39153e590c8, content=<a href='/topic/show?id=221799151b3' target=_blank style='color:#2F92EE;'>#静脉溶栓治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99151, encryptionId=221799151b3, topicName=静脉溶栓治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4e9812877003, createdName=bettycmoon, createdTime=Wed Jan 20 11:24:27 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026751, encodeId=e9a71026e51c0, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Mon Jan 18 23:24:27 CST 2021, time=2021-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036403, encodeId=1f1a103640379, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Mon Jan 18 23:24:27 CST 2021, time=2021-01-18, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1706164, encodeId=8ddf1e06164f7, content=<a href='/topic/show?id=7f6443986ec' target=_blank style='color:#2F92EE;'>#大血管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43986, encryptionId=7f6443986ec, topicName=大血管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=caff31165455, createdName=kkunny, createdTime=Mon Jan 03 13:24:27 CST 2022, time=2022-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2009870, encodeId=277020098e0b8, content=<a href='/topic/show?id=467789803a9' target=_blank style='color:#2F92EE;'>#血管闭塞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89803, encryptionId=467789803a9, topicName=血管闭塞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=827b160, createdName=cnxcy, createdTime=Wed Oct 13 20:24:27 CST 2021, time=2021-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1698188, encodeId=8cb6169818822, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Wed Nov 24 21:24:27 CST 2021, time=2021-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1283161, encodeId=a578128316112, content=<a href='/topic/show?id=4fade445192' target=_blank style='color:#2F92EE;'>#神经系统#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74451, encryptionId=4fade445192, topicName=神经系统)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=02f5179, createdName=luoxiaog, createdTime=Wed Jan 20 11:24:27 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1418590, encodeId=783e141859011, content=<a href='/topic/show?id=b88266482f7' target=_blank style='color:#2F92EE;'>#溶栓治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66482, encryptionId=b88266482f7, topicName=溶栓治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=00673387794, createdName=lqvr, createdTime=Wed Jan 20 11:24:27 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1537590, encodeId=da39153e590c8, content=<a href='/topic/show?id=221799151b3' target=_blank style='color:#2F92EE;'>#静脉溶栓治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99151, encryptionId=221799151b3, topicName=静脉溶栓治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4e9812877003, createdName=bettycmoon, createdTime=Wed Jan 20 11:24:27 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026751, encodeId=e9a71026e51c0, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Mon Jan 18 23:24:27 CST 2021, time=2021-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036403, encodeId=1f1a103640379, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Mon Jan 18 23:24:27 CST 2021, time=2021-01-18, status=1, ipAttribution=)]
    2021-11-24 fusion
  4. [GetPortalCommentsPageByObjectIdResponse(id=1706164, encodeId=8ddf1e06164f7, content=<a href='/topic/show?id=7f6443986ec' target=_blank style='color:#2F92EE;'>#大血管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43986, encryptionId=7f6443986ec, topicName=大血管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=caff31165455, createdName=kkunny, createdTime=Mon Jan 03 13:24:27 CST 2022, time=2022-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2009870, encodeId=277020098e0b8, content=<a href='/topic/show?id=467789803a9' target=_blank style='color:#2F92EE;'>#血管闭塞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89803, encryptionId=467789803a9, topicName=血管闭塞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=827b160, createdName=cnxcy, createdTime=Wed Oct 13 20:24:27 CST 2021, time=2021-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1698188, encodeId=8cb6169818822, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Wed Nov 24 21:24:27 CST 2021, time=2021-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1283161, encodeId=a578128316112, content=<a href='/topic/show?id=4fade445192' target=_blank style='color:#2F92EE;'>#神经系统#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74451, encryptionId=4fade445192, topicName=神经系统)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=02f5179, createdName=luoxiaog, createdTime=Wed Jan 20 11:24:27 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1418590, encodeId=783e141859011, content=<a href='/topic/show?id=b88266482f7' target=_blank style='color:#2F92EE;'>#溶栓治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66482, encryptionId=b88266482f7, topicName=溶栓治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=00673387794, createdName=lqvr, createdTime=Wed Jan 20 11:24:27 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1537590, encodeId=da39153e590c8, content=<a href='/topic/show?id=221799151b3' target=_blank style='color:#2F92EE;'>#静脉溶栓治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99151, encryptionId=221799151b3, topicName=静脉溶栓治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4e9812877003, createdName=bettycmoon, createdTime=Wed Jan 20 11:24:27 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026751, encodeId=e9a71026e51c0, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Mon Jan 18 23:24:27 CST 2021, time=2021-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036403, encodeId=1f1a103640379, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Mon Jan 18 23:24:27 CST 2021, time=2021-01-18, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1706164, encodeId=8ddf1e06164f7, content=<a href='/topic/show?id=7f6443986ec' target=_blank style='color:#2F92EE;'>#大血管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43986, encryptionId=7f6443986ec, topicName=大血管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=caff31165455, createdName=kkunny, createdTime=Mon Jan 03 13:24:27 CST 2022, time=2022-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2009870, encodeId=277020098e0b8, content=<a href='/topic/show?id=467789803a9' target=_blank style='color:#2F92EE;'>#血管闭塞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89803, encryptionId=467789803a9, topicName=血管闭塞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=827b160, createdName=cnxcy, createdTime=Wed Oct 13 20:24:27 CST 2021, time=2021-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1698188, encodeId=8cb6169818822, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Wed Nov 24 21:24:27 CST 2021, time=2021-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1283161, encodeId=a578128316112, content=<a href='/topic/show?id=4fade445192' target=_blank style='color:#2F92EE;'>#神经系统#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74451, encryptionId=4fade445192, topicName=神经系统)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=02f5179, createdName=luoxiaog, createdTime=Wed Jan 20 11:24:27 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1418590, encodeId=783e141859011, content=<a href='/topic/show?id=b88266482f7' target=_blank style='color:#2F92EE;'>#溶栓治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66482, encryptionId=b88266482f7, topicName=溶栓治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=00673387794, createdName=lqvr, createdTime=Wed Jan 20 11:24:27 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1537590, encodeId=da39153e590c8, content=<a href='/topic/show?id=221799151b3' target=_blank style='color:#2F92EE;'>#静脉溶栓治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99151, encryptionId=221799151b3, topicName=静脉溶栓治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4e9812877003, createdName=bettycmoon, createdTime=Wed Jan 20 11:24:27 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026751, encodeId=e9a71026e51c0, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Mon Jan 18 23:24:27 CST 2021, time=2021-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036403, encodeId=1f1a103640379, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Mon Jan 18 23:24:27 CST 2021, time=2021-01-18, status=1, ipAttribution=)]
    2021-01-20 lqvr
  6. [GetPortalCommentsPageByObjectIdResponse(id=1706164, encodeId=8ddf1e06164f7, content=<a href='/topic/show?id=7f6443986ec' target=_blank style='color:#2F92EE;'>#大血管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43986, encryptionId=7f6443986ec, topicName=大血管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=caff31165455, createdName=kkunny, createdTime=Mon Jan 03 13:24:27 CST 2022, time=2022-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2009870, encodeId=277020098e0b8, content=<a href='/topic/show?id=467789803a9' target=_blank style='color:#2F92EE;'>#血管闭塞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89803, encryptionId=467789803a9, topicName=血管闭塞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=827b160, createdName=cnxcy, createdTime=Wed Oct 13 20:24:27 CST 2021, time=2021-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1698188, encodeId=8cb6169818822, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Wed Nov 24 21:24:27 CST 2021, time=2021-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1283161, encodeId=a578128316112, content=<a href='/topic/show?id=4fade445192' target=_blank style='color:#2F92EE;'>#神经系统#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74451, encryptionId=4fade445192, topicName=神经系统)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=02f5179, createdName=luoxiaog, createdTime=Wed Jan 20 11:24:27 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1418590, encodeId=783e141859011, content=<a href='/topic/show?id=b88266482f7' target=_blank style='color:#2F92EE;'>#溶栓治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66482, encryptionId=b88266482f7, topicName=溶栓治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=00673387794, createdName=lqvr, createdTime=Wed Jan 20 11:24:27 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1537590, encodeId=da39153e590c8, content=<a href='/topic/show?id=221799151b3' target=_blank style='color:#2F92EE;'>#静脉溶栓治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99151, encryptionId=221799151b3, topicName=静脉溶栓治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4e9812877003, createdName=bettycmoon, createdTime=Wed Jan 20 11:24:27 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026751, encodeId=e9a71026e51c0, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Mon Jan 18 23:24:27 CST 2021, time=2021-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036403, encodeId=1f1a103640379, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Mon Jan 18 23:24:27 CST 2021, time=2021-01-18, status=1, ipAttribution=)]
  7. [GetPortalCommentsPageByObjectIdResponse(id=1706164, encodeId=8ddf1e06164f7, content=<a href='/topic/show?id=7f6443986ec' target=_blank style='color:#2F92EE;'>#大血管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43986, encryptionId=7f6443986ec, topicName=大血管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=caff31165455, createdName=kkunny, createdTime=Mon Jan 03 13:24:27 CST 2022, time=2022-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2009870, encodeId=277020098e0b8, content=<a href='/topic/show?id=467789803a9' target=_blank style='color:#2F92EE;'>#血管闭塞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89803, encryptionId=467789803a9, topicName=血管闭塞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=827b160, createdName=cnxcy, createdTime=Wed Oct 13 20:24:27 CST 2021, time=2021-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1698188, encodeId=8cb6169818822, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Wed Nov 24 21:24:27 CST 2021, time=2021-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1283161, encodeId=a578128316112, content=<a href='/topic/show?id=4fade445192' target=_blank style='color:#2F92EE;'>#神经系统#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74451, encryptionId=4fade445192, topicName=神经系统)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=02f5179, createdName=luoxiaog, createdTime=Wed Jan 20 11:24:27 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1418590, encodeId=783e141859011, content=<a href='/topic/show?id=b88266482f7' target=_blank style='color:#2F92EE;'>#溶栓治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66482, encryptionId=b88266482f7, topicName=溶栓治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=00673387794, createdName=lqvr, createdTime=Wed Jan 20 11:24:27 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1537590, encodeId=da39153e590c8, content=<a href='/topic/show?id=221799151b3' target=_blank style='color:#2F92EE;'>#静脉溶栓治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99151, encryptionId=221799151b3, topicName=静脉溶栓治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4e9812877003, createdName=bettycmoon, createdTime=Wed Jan 20 11:24:27 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026751, encodeId=e9a71026e51c0, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Mon Jan 18 23:24:27 CST 2021, time=2021-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036403, encodeId=1f1a103640379, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Mon Jan 18 23:24:27 CST 2021, time=2021-01-18, status=1, ipAttribution=)]
    2021-01-18 健健

    卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1706164, encodeId=8ddf1e06164f7, content=<a href='/topic/show?id=7f6443986ec' target=_blank style='color:#2F92EE;'>#大血管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43986, encryptionId=7f6443986ec, topicName=大血管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=caff31165455, createdName=kkunny, createdTime=Mon Jan 03 13:24:27 CST 2022, time=2022-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2009870, encodeId=277020098e0b8, content=<a href='/topic/show?id=467789803a9' target=_blank style='color:#2F92EE;'>#血管闭塞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89803, encryptionId=467789803a9, topicName=血管闭塞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=827b160, createdName=cnxcy, createdTime=Wed Oct 13 20:24:27 CST 2021, time=2021-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1698188, encodeId=8cb6169818822, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Wed Nov 24 21:24:27 CST 2021, time=2021-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1283161, encodeId=a578128316112, content=<a href='/topic/show?id=4fade445192' target=_blank style='color:#2F92EE;'>#神经系统#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74451, encryptionId=4fade445192, topicName=神经系统)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=02f5179, createdName=luoxiaog, createdTime=Wed Jan 20 11:24:27 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1418590, encodeId=783e141859011, content=<a href='/topic/show?id=b88266482f7' target=_blank style='color:#2F92EE;'>#溶栓治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66482, encryptionId=b88266482f7, topicName=溶栓治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=00673387794, createdName=lqvr, createdTime=Wed Jan 20 11:24:27 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1537590, encodeId=da39153e590c8, content=<a href='/topic/show?id=221799151b3' target=_blank style='color:#2F92EE;'>#静脉溶栓治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99151, encryptionId=221799151b3, topicName=静脉溶栓治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4e9812877003, createdName=bettycmoon, createdTime=Wed Jan 20 11:24:27 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026751, encodeId=e9a71026e51c0, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Mon Jan 18 23:24:27 CST 2021, time=2021-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036403, encodeId=1f1a103640379, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Mon Jan 18 23:24:27 CST 2021, time=2021-01-18, status=1, ipAttribution=)]
    2021-01-18 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0