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Neurology:副肿瘤性脑血管炎1例

2018-03-15 杨中华 脑血管病及重症文献导读

47岁,女性。因突发剧烈头痛,呕吐,随后意识障碍到急诊室就诊。

47岁,女性。

因突发剧烈头痛,呕吐,随后意识障碍到急诊室就诊。

查体发现多处淋巴结肿大,左侧乳腺溃疡肿块。GCS 9分,颈强直,Kernig征阳性。多组颅神经损伤。

怀疑癌性脑膜炎和出血性软脑膜转移。平扫CT显示双侧顶叶脑沟内SAH(下图A)。CTA未见动脉瘤、血管畸形等。MRI显示双侧顶枕区域SAH(下图B和C),MRV正常。

下图,A图为平扫CT,显示双侧顶枕脑沟内出血(黄色箭头)。B图为Flair(白色箭头),C图为SWI(黄色箭头)显示双侧顶枕脑沟内出血:



根据症状体征和影像学检查,临床怀疑副肿瘤可逆脑血管痉挛伴凸面SAH。随后DSA检查,发现小血管广泛和多处狭窄,提示血管痉挛或脑血管炎(下图D)。

下图D为DSA,显示血管呈串珠样改变(绿色箭头):



脑脊液发现恶性肿瘤,确诊肿瘤性脑膜炎。

乳腺活检为导管浸润癌III级。

入院第4天死亡,随后进行了尸体解剖。

病理证实癌性脑膜炎。血管周围间隙扩大,充满了肿瘤细胞(下图E)。

下图E显示蛛网膜下腔和血管周围间隙(黄色箭头)扩大,充满肿瘤细胞。小血管呈现血管炎表现(蓝色箭头,HE染色):



脊膜和神经根广泛肿瘤浸润(infiltration)。Willis环血管的较小分支显示动脉周围浸润(infiltration),内膜炎症和纤维素沉积,无坏死或肉芽肿形成(图F)。

下图F为软脑膜血管血管炎(黄色箭头),合并纤维蛋白血栓形成(蓝色箭头),被肿瘤细胞包围(HE染色):



这些特征符合副肿瘤性血管炎的表现。较大的脑血管被肿瘤细胞包裹(encased),但是无浸润(infiltration)。

最终该患者诊断乳腺癌转移,癌性脑膜炎伴副肿瘤性脑血管炎和凸面SAH。

作者认为副肿瘤性脑血管炎的病理生理机制包括:1.肿瘤细胞诱导针对血管内皮的免疫反应,2.肿瘤细胞释放各种促炎性因子对内皮的损伤,3.肿瘤蛋白沉积在血管壁上,随后产生迟发性过敏反应,4.含有肿瘤抗原的循环免疫复合物沉积在血管壁上。

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  1. [GetPortalCommentsPageByObjectIdResponse(id=2000356, encodeId=9f092000356b0, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Thu Aug 02 11:30:00 CST 2018, time=2018-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=298923, encodeId=8690298923a4, content=学习了谢谢分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Fri Mar 23 09:37:10 CST 2018, time=2018-03-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=297640, encodeId=c91d29e640cb, content=学习并分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Mon Mar 19 07:15:43 CST 2018, time=2018-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1263185, encodeId=9cc51263185e5, content=<a href='/topic/show?id=581e8968859' target=_blank style='color:#2F92EE;'>#血管炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89688, encryptionId=581e8968859, topicName=血管炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=909c71, createdName=shijzhiewnjhch, createdTime=Sat Mar 17 12:30:00 CST 2018, time=2018-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296563, encodeId=c4f8296563cf, content=作者认为副肿瘤性脑血管炎的病理生理机制包括:1.肿瘤细胞诱导针对血管内皮的免疫反应.2.肿瘤细胞释放各种促炎性因子对内皮的损伤.3.肿瘤蛋白沉积在血管壁上.随后产生迟发性过敏反应.4.含有肿瘤抗原的循环免疫复合物沉积在血管壁上., beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Thu Mar 15 22:47:29 CST 2018, time=2018-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296557, encodeId=e0cf29655ef1, content=不错的文章值得拥有, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=eff51996281, createdName=1e1b8538m79(暂无匿称), createdTime=Thu Mar 15 22:08:35 CST 2018, time=2018-03-15, status=1, ipAttribution=)]
    2018-08-02 yinhl1978
  2. [GetPortalCommentsPageByObjectIdResponse(id=2000356, encodeId=9f092000356b0, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Thu Aug 02 11:30:00 CST 2018, time=2018-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=298923, encodeId=8690298923a4, content=学习了谢谢分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Fri Mar 23 09:37:10 CST 2018, time=2018-03-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=297640, encodeId=c91d29e640cb, content=学习并分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Mon Mar 19 07:15:43 CST 2018, time=2018-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1263185, encodeId=9cc51263185e5, content=<a href='/topic/show?id=581e8968859' target=_blank style='color:#2F92EE;'>#血管炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89688, encryptionId=581e8968859, topicName=血管炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=909c71, createdName=shijzhiewnjhch, createdTime=Sat Mar 17 12:30:00 CST 2018, time=2018-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296563, encodeId=c4f8296563cf, content=作者认为副肿瘤性脑血管炎的病理生理机制包括:1.肿瘤细胞诱导针对血管内皮的免疫反应.2.肿瘤细胞释放各种促炎性因子对内皮的损伤.3.肿瘤蛋白沉积在血管壁上.随后产生迟发性过敏反应.4.含有肿瘤抗原的循环免疫复合物沉积在血管壁上., beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Thu Mar 15 22:47:29 CST 2018, time=2018-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296557, encodeId=e0cf29655ef1, content=不错的文章值得拥有, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=eff51996281, createdName=1e1b8538m79(暂无匿称), createdTime=Thu Mar 15 22:08:35 CST 2018, time=2018-03-15, status=1, ipAttribution=)]
    2018-03-23 大爰

    学习了谢谢分享!!

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=2000356, encodeId=9f092000356b0, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Thu Aug 02 11:30:00 CST 2018, time=2018-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=298923, encodeId=8690298923a4, content=学习了谢谢分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Fri Mar 23 09:37:10 CST 2018, time=2018-03-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=297640, encodeId=c91d29e640cb, content=学习并分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Mon Mar 19 07:15:43 CST 2018, time=2018-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1263185, encodeId=9cc51263185e5, content=<a href='/topic/show?id=581e8968859' target=_blank style='color:#2F92EE;'>#血管炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89688, encryptionId=581e8968859, topicName=血管炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=909c71, createdName=shijzhiewnjhch, createdTime=Sat Mar 17 12:30:00 CST 2018, time=2018-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296563, encodeId=c4f8296563cf, content=作者认为副肿瘤性脑血管炎的病理生理机制包括:1.肿瘤细胞诱导针对血管内皮的免疫反应.2.肿瘤细胞释放各种促炎性因子对内皮的损伤.3.肿瘤蛋白沉积在血管壁上.随后产生迟发性过敏反应.4.含有肿瘤抗原的循环免疫复合物沉积在血管壁上., beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Thu Mar 15 22:47:29 CST 2018, time=2018-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296557, encodeId=e0cf29655ef1, content=不错的文章值得拥有, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=eff51996281, createdName=1e1b8538m79(暂无匿称), createdTime=Thu Mar 15 22:08:35 CST 2018, time=2018-03-15, status=1, ipAttribution=)]
    2018-03-19 大爰

    学习并分享!!

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=2000356, encodeId=9f092000356b0, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Thu Aug 02 11:30:00 CST 2018, time=2018-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=298923, encodeId=8690298923a4, content=学习了谢谢分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Fri Mar 23 09:37:10 CST 2018, time=2018-03-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=297640, encodeId=c91d29e640cb, content=学习并分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Mon Mar 19 07:15:43 CST 2018, time=2018-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1263185, encodeId=9cc51263185e5, content=<a href='/topic/show?id=581e8968859' target=_blank style='color:#2F92EE;'>#血管炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89688, encryptionId=581e8968859, topicName=血管炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=909c71, createdName=shijzhiewnjhch, createdTime=Sat Mar 17 12:30:00 CST 2018, time=2018-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296563, encodeId=c4f8296563cf, content=作者认为副肿瘤性脑血管炎的病理生理机制包括:1.肿瘤细胞诱导针对血管内皮的免疫反应.2.肿瘤细胞释放各种促炎性因子对内皮的损伤.3.肿瘤蛋白沉积在血管壁上.随后产生迟发性过敏反应.4.含有肿瘤抗原的循环免疫复合物沉积在血管壁上., beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Thu Mar 15 22:47:29 CST 2018, time=2018-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296557, encodeId=e0cf29655ef1, content=不错的文章值得拥有, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=eff51996281, createdName=1e1b8538m79(暂无匿称), createdTime=Thu Mar 15 22:08:35 CST 2018, time=2018-03-15, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=2000356, encodeId=9f092000356b0, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Thu Aug 02 11:30:00 CST 2018, time=2018-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=298923, encodeId=8690298923a4, content=学习了谢谢分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Fri Mar 23 09:37:10 CST 2018, time=2018-03-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=297640, encodeId=c91d29e640cb, content=学习并分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Mon Mar 19 07:15:43 CST 2018, time=2018-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1263185, encodeId=9cc51263185e5, content=<a href='/topic/show?id=581e8968859' target=_blank style='color:#2F92EE;'>#血管炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89688, encryptionId=581e8968859, topicName=血管炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=909c71, createdName=shijzhiewnjhch, createdTime=Sat Mar 17 12:30:00 CST 2018, time=2018-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296563, encodeId=c4f8296563cf, content=作者认为副肿瘤性脑血管炎的病理生理机制包括:1.肿瘤细胞诱导针对血管内皮的免疫反应.2.肿瘤细胞释放各种促炎性因子对内皮的损伤.3.肿瘤蛋白沉积在血管壁上.随后产生迟发性过敏反应.4.含有肿瘤抗原的循环免疫复合物沉积在血管壁上., beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Thu Mar 15 22:47:29 CST 2018, time=2018-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296557, encodeId=e0cf29655ef1, content=不错的文章值得拥有, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=eff51996281, createdName=1e1b8538m79(暂无匿称), createdTime=Thu Mar 15 22:08:35 CST 2018, time=2018-03-15, status=1, ipAttribution=)]
    2018-03-15 有备才能无患

    作者认为副肿瘤性脑血管炎的病理生理机制包括:1.肿瘤细胞诱导针对血管内皮的免疫反应.2.肿瘤细胞释放各种促炎性因子对内皮的损伤.3.肿瘤蛋白沉积在血管壁上.随后产生迟发性过敏反应.4.含有肿瘤抗原的循环免疫复合物沉积在血管壁上.

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=2000356, encodeId=9f092000356b0, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Thu Aug 02 11:30:00 CST 2018, time=2018-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=298923, encodeId=8690298923a4, content=学习了谢谢分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Fri Mar 23 09:37:10 CST 2018, time=2018-03-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=297640, encodeId=c91d29e640cb, content=学习并分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Mon Mar 19 07:15:43 CST 2018, time=2018-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1263185, encodeId=9cc51263185e5, content=<a href='/topic/show?id=581e8968859' target=_blank style='color:#2F92EE;'>#血管炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89688, encryptionId=581e8968859, topicName=血管炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=909c71, createdName=shijzhiewnjhch, createdTime=Sat Mar 17 12:30:00 CST 2018, time=2018-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296563, encodeId=c4f8296563cf, content=作者认为副肿瘤性脑血管炎的病理生理机制包括:1.肿瘤细胞诱导针对血管内皮的免疫反应.2.肿瘤细胞释放各种促炎性因子对内皮的损伤.3.肿瘤蛋白沉积在血管壁上.随后产生迟发性过敏反应.4.含有肿瘤抗原的循环免疫复合物沉积在血管壁上., beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Thu Mar 15 22:47:29 CST 2018, time=2018-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296557, encodeId=e0cf29655ef1, content=不错的文章值得拥有, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=eff51996281, createdName=1e1b8538m79(暂无匿称), createdTime=Thu Mar 15 22:08:35 CST 2018, time=2018-03-15, status=1, ipAttribution=)]
    2018-03-15 1e1b8538m79(暂无匿称)

    不错的文章值得拥有

    0

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