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如何鉴别血管源性、细胞毒性、间质性脑水肿？

2021-11-04 Neurosurgery Neurosurgery

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脑水肿分为血管源性脑水肿、细胞性水肿和间质性脑水肿。

脑水肿分为血管源性脑水肿、细胞性水肿和间质性脑水肿。

血管源性脑水肿
 
主因血脑屏障受损、破坏，致毛细血管通透性增加，水分渗出增多，积存于血管周围及细胞间质所致。此时，由于一些蛋白物质随水分经血管壁通透到细胞外液中，使细胞外液渗透压升高，水分由血管壁渗出增多，致使脑水肿继续发展，脑外伤所导致的外伤性脑水肿早期主要为血管源性脑水肿。发病部位为脑白质。典型疾病如肿瘤、脓肿、脑炎。
 
下图为胶质母细胞瘤，肿瘤使周围脑组织受压或阻塞脑静脉回流，静脉压升高，脑脊液循环机吸收障碍，以及肿瘤生物毒性作用等，使肿瘤周围的脑组织受影响，血脑屏障损害或破坏，血管壁通透性增加，产生局限性血管源性脑水肿。
 
FLAIR序列肿瘤为稍高信号，肿瘤周围白质内见不规则形高信号水肿，勾勒出局部脑白质形态。
T1增强扫描可以看到肿瘤实体呈花环状强化，而周围水肿无强化。
波谱显示Cho峰明显增高，NAA峰减低。
 
细胞性脑水肿      
 
细胞性脑水肿是不同的致病因素，使细胞内外环境改变，脑组织缺氧，影响神经细胞代谢，细胞膜系统功能障碍，线粒体三磷酸腺苷生成减少，神经细胞膜的钠-钾泵、钙-镁泵等活性降低，使神经细胞内外的钠、钾钙等离子交换障碍。这些因素均可导致细胞内水肿。此类水肿时，血脑屏障可不受影响，血管周围间隙及细胞外间隙无明显扩大，细胞内水肿液不含蛋白，钠、氯离子水平增高。特点为细胞内水钠聚集，水肿部位累及灰、白质，典型疾病为缺血缺氧早期。
 
下图为急性期脑梗死的患者，DWI示左侧额叶见明显片状高信号，责任血管为左侧大脑中动脉额叶分支。
 
间质性脑水肿         

 

又称脑积水性脑水肿，常见于梗阻性脑积水。不同病因引起梗阻性脑积水，使脑室系统扩大，尤以侧脑室扩大为甚，致使脑室内压力显著高于脑组织内的压力。产生脑室内-脑组织内压力梯度，这种压力梯度的显著差别，使脑室内液体可以透过脑室室管膜到脑室周围脑组织中，形成脑室周围白质脑水肿。
 
下图为一例梗阻性脑积水的患者，双侧侧脑室明显扩张，侧脑室前角旁可见新月形长T2信号的水肿带。
 
 
DWI序列中由于髓母细胞瘤组织细胞排列紧密，呈典型高信号
 
T1增强矢状位四脑室的病灶呈轻度不均匀强化

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    2022-01-30 zjshifan_98647306

    #间质性#

    0

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    2021-11-06 gaoxiaoe

    #脑水肿#

    0

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    2021-11-06 小华子

    #水肿#

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1815851, encodeId=98ed18158513d, content=<a href='/topic/show?id=82e99e291b0' target=_blank style='color:#2F92EE;'>#间质性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97291, encryptionId=82e99e291b0, topicName=间质性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=99cf2500102, createdName=zjshifan_98647306, createdTime=Sun Jan 30 04:26:26 CST 2022, time=2022-01-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1259611, encodeId=64901259611a9, content=<a href='/topic/show?id=1d2f8490308' target=_blank style='color:#2F92EE;'>#脑水肿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84903, encryptionId=1d2f8490308, topicName=脑水肿)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Sat Nov 06 08:26:26 CST 2021, time=2021-11-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1333493, encodeId=b3a51333493b2, content=<a href='/topic/show?id=4ce26423802' target=_blank style='color:#2F92EE;'>#水肿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64238, encryptionId=4ce26423802, topicName=水肿)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKCRibWHQArPHdSkqP90U1HwwqlGeU7BUgzY240D3v2ibBDJ09ybkGkwOjxz7qRmngZaGlK1taX6hfA/132, createdBy=2e772500094, createdName=小华子, createdTime=Sat Nov 06 08:26:26 CST 2021, time=2021-11-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1529539, encodeId=ceef15295390f, content=<a href='/topic/show?id=a02ce793707' target=_blank style='color:#2F92EE;'>#细胞毒性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77937, encryptionId=a02ce793707, topicName=细胞毒性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=10b211951227, createdName=appleandpeer, createdTime=Sat Nov 06 08:26:26 CST 2021, time=2021-11-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1067436, encodeId=ba5b106e436ee, content=厉害棒棒棒, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLWROGia7f3ficvom5MMQRnYVzLg9ibA7gJvvUeGDuylYP3de77n3NvQucKFsdz5F2npWEA3arQwxrKQ/132, createdBy=09ed2341770, createdName=心之方向, createdTime=Fri Nov 05 23:29:58 CST 2021, time=2021-11-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1067164, encodeId=870a106e16439, content=值得学习！, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211030/727082c36c794e7a9cc18aad6a2886d1/d8e51d61f5f74b299541d33450410b09.jpg, createdBy=26f72982264, createdName=海阔天空Sin, createdTime=Fri Nov 05 08:34:33 CST 2021, time=2021-11-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1067126, encodeId=101e106e1264c, content=默里大学下属的非营利组织DRIVE（Drug, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Fri Nov 05 06:00:36 CST 2021, time=2021-11-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1067099, encodeId=1f0e106e099dc, content=经典知识复习, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7e831560211, createdName=ZYY7209, createdTime=Thu Nov 04 23:15:08 CST 2021, time=2021-11-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1067055, encodeId=d05c106e0555f, content=厉害了，又学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=65aa5643711, createdName=小白努力长高高, createdTime=Thu Nov 04 21:30:22 CST 2021, time=2021-11-04, status=1, ipAttribution=)]
    2021-11-06 appleandpeer

    #细胞毒性#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1815851, encodeId=98ed18158513d, content=<a href='/topic/show?id=82e99e291b0' target=_blank style='color:#2F92EE;'>#间质性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97291, encryptionId=82e99e291b0, topicName=间质性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=99cf2500102, createdName=zjshifan_98647306, createdTime=Sun Jan 30 04:26:26 CST 2022, time=2022-01-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1259611, encodeId=64901259611a9, content=<a href='/topic/show?id=1d2f8490308' target=_blank style='color:#2F92EE;'>#脑水肿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84903, encryptionId=1d2f8490308, topicName=脑水肿)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Sat Nov 06 08:26:26 CST 2021, time=2021-11-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1333493, encodeId=b3a51333493b2, content=<a href='/topic/show?id=4ce26423802' target=_blank style='color:#2F92EE;'>#水肿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64238, encryptionId=4ce26423802, topicName=水肿)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKCRibWHQArPHdSkqP90U1HwwqlGeU7BUgzY240D3v2ibBDJ09ybkGkwOjxz7qRmngZaGlK1taX6hfA/132, createdBy=2e772500094, createdName=小华子, createdTime=Sat Nov 06 08:26:26 CST 2021, time=2021-11-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1529539, encodeId=ceef15295390f, content=<a href='/topic/show?id=a02ce793707' target=_blank style='color:#2F92EE;'>#细胞毒性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77937, encryptionId=a02ce793707, topicName=细胞毒性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=10b211951227, createdName=appleandpeer, createdTime=Sat Nov 06 08:26:26 CST 2021, time=2021-11-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1067436, encodeId=ba5b106e436ee, content=厉害棒棒棒, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLWROGia7f3ficvom5MMQRnYVzLg9ibA7gJvvUeGDuylYP3de77n3NvQucKFsdz5F2npWEA3arQwxrKQ/132, createdBy=09ed2341770, createdName=心之方向, createdTime=Fri Nov 05 23:29:58 CST 2021, time=2021-11-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1067164, encodeId=870a106e16439, content=值得学习！, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211030/727082c36c794e7a9cc18aad6a2886d1/d8e51d61f5f74b299541d33450410b09.jpg, createdBy=26f72982264, createdName=海阔天空Sin, createdTime=Fri Nov 05 08:34:33 CST 2021, time=2021-11-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1067126, encodeId=101e106e1264c, content=默里大学下属的非营利组织DRIVE（Drug, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Fri Nov 05 06:00:36 CST 2021, time=2021-11-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1067099, encodeId=1f0e106e099dc, content=经典知识复习, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7e831560211, createdName=ZYY7209, createdTime=Thu Nov 04 23:15:08 CST 2021, time=2021-11-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1067055, encodeId=d05c106e0555f, content=厉害了，又学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=65aa5643711, createdName=小白努力长高高, createdTime=Thu Nov 04 21:30:22 CST 2021, time=2021-11-04, status=1, ipAttribution=)]
    2021-11-05 心之方向

    厉害棒棒棒

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1815851, encodeId=98ed18158513d, content=<a href='/topic/show?id=82e99e291b0' target=_blank style='color:#2F92EE;'>#间质性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97291, encryptionId=82e99e291b0, topicName=间质性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=99cf2500102, createdName=zjshifan_98647306, createdTime=Sun Jan 30 04:26:26 CST 2022, time=2022-01-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1259611, encodeId=64901259611a9, content=<a href='/topic/show?id=1d2f8490308' target=_blank style='color:#2F92EE;'>#脑水肿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84903, encryptionId=1d2f8490308, topicName=脑水肿)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Sat Nov 06 08:26:26 CST 2021, time=2021-11-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1333493, encodeId=b3a51333493b2, content=<a href='/topic/show?id=4ce26423802' target=_blank style='color:#2F92EE;'>#水肿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64238, encryptionId=4ce26423802, topicName=水肿)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKCRibWHQArPHdSkqP90U1HwwqlGeU7BUgzY240D3v2ibBDJ09ybkGkwOjxz7qRmngZaGlK1taX6hfA/132, createdBy=2e772500094, createdName=小华子, createdTime=Sat Nov 06 08:26:26 CST 2021, time=2021-11-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1529539, encodeId=ceef15295390f, content=<a href='/topic/show?id=a02ce793707' target=_blank style='color:#2F92EE;'>#细胞毒性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77937, encryptionId=a02ce793707, topicName=细胞毒性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=10b211951227, createdName=appleandpeer, createdTime=Sat Nov 06 08:26:26 CST 2021, time=2021-11-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1067436, encodeId=ba5b106e436ee, content=厉害棒棒棒, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLWROGia7f3ficvom5MMQRnYVzLg9ibA7gJvvUeGDuylYP3de77n3NvQucKFsdz5F2npWEA3arQwxrKQ/132, createdBy=09ed2341770, createdName=心之方向, createdTime=Fri Nov 05 23:29:58 CST 2021, time=2021-11-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1067164, encodeId=870a106e16439, content=值得学习！, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211030/727082c36c794e7a9cc18aad6a2886d1/d8e51d61f5f74b299541d33450410b09.jpg, createdBy=26f72982264, createdName=海阔天空Sin, createdTime=Fri Nov 05 08:34:33 CST 2021, time=2021-11-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1067126, encodeId=101e106e1264c, content=默里大学下属的非营利组织DRIVE（Drug, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Fri Nov 05 06:00:36 CST 2021, time=2021-11-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1067099, encodeId=1f0e106e099dc, content=经典知识复习, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7e831560211, createdName=ZYY7209, createdTime=Thu Nov 04 23:15:08 CST 2021, time=2021-11-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1067055, encodeId=d05c106e0555f, content=厉害了，又学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=65aa5643711, createdName=小白努力长高高, createdTime=Thu Nov 04 21:30:22 CST 2021, time=2021-11-04, status=1, ipAttribution=)]
    2021-11-05 海阔天空Sin

    值得学习！

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1815851, encodeId=98ed18158513d, content=<a href='/topic/show?id=82e99e291b0' target=_blank style='color:#2F92EE;'>#间质性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97291, encryptionId=82e99e291b0, topicName=间质性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=99cf2500102, createdName=zjshifan_98647306, createdTime=Sun Jan 30 04:26:26 CST 2022, time=2022-01-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1259611, encodeId=64901259611a9, content=<a href='/topic/show?id=1d2f8490308' target=_blank style='color:#2F92EE;'>#脑水肿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84903, encryptionId=1d2f8490308, topicName=脑水肿)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Sat Nov 06 08:26:26 CST 2021, time=2021-11-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1333493, encodeId=b3a51333493b2, content=<a href='/topic/show?id=4ce26423802' target=_blank style='color:#2F92EE;'>#水肿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64238, encryptionId=4ce26423802, topicName=水肿)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKCRibWHQArPHdSkqP90U1HwwqlGeU7BUgzY240D3v2ibBDJ09ybkGkwOjxz7qRmngZaGlK1taX6hfA/132, createdBy=2e772500094, createdName=小华子, createdTime=Sat Nov 06 08:26:26 CST 2021, time=2021-11-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1529539, encodeId=ceef15295390f, content=<a href='/topic/show?id=a02ce793707' target=_blank style='color:#2F92EE;'>#细胞毒性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77937, encryptionId=a02ce793707, topicName=细胞毒性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=10b211951227, createdName=appleandpeer, createdTime=Sat Nov 06 08:26:26 CST 2021, time=2021-11-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1067436, encodeId=ba5b106e436ee, content=厉害棒棒棒, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLWROGia7f3ficvom5MMQRnYVzLg9ibA7gJvvUeGDuylYP3de77n3NvQucKFsdz5F2npWEA3arQwxrKQ/132, createdBy=09ed2341770, createdName=心之方向, createdTime=Fri Nov 05 23:29:58 CST 2021, time=2021-11-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1067164, encodeId=870a106e16439, content=值得学习！, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211030/727082c36c794e7a9cc18aad6a2886d1/d8e51d61f5f74b299541d33450410b09.jpg, createdBy=26f72982264, createdName=海阔天空Sin, createdTime=Fri Nov 05 08:34:33 CST 2021, time=2021-11-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1067126, encodeId=101e106e1264c, content=默里大学下属的非营利组织DRIVE（Drug, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Fri Nov 05 06:00:36 CST 2021, time=2021-11-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1067099, encodeId=1f0e106e099dc, content=经典知识复习, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7e831560211, createdName=ZYY7209, createdTime=Thu Nov 04 23:15:08 CST 2021, time=2021-11-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1067055, encodeId=d05c106e0555f, content=厉害了，又学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=65aa5643711, createdName=小白努力长高高, createdTime=Thu Nov 04 21:30:22 CST 2021, time=2021-11-04, status=1, ipAttribution=)]
    2021-11-05 查查佳佳

    默里大学下属的非营利组织DRIVE（Drug

    0

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    2021-11-04 ZYY7209

    经典知识复习

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=1815851, encodeId=98ed18158513d, content=<a href='/topic/show?id=82e99e291b0' target=_blank style='color:#2F92EE;'>#间质性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97291, encryptionId=82e99e291b0, topicName=间质性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=99cf2500102, createdName=zjshifan_98647306, createdTime=Sun Jan 30 04:26:26 CST 2022, time=2022-01-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1259611, encodeId=64901259611a9, content=<a href='/topic/show?id=1d2f8490308' target=_blank style='color:#2F92EE;'>#脑水肿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84903, encryptionId=1d2f8490308, topicName=脑水肿)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Sat Nov 06 08:26:26 CST 2021, time=2021-11-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1333493, encodeId=b3a51333493b2, content=<a href='/topic/show?id=4ce26423802' target=_blank style='color:#2F92EE;'>#水肿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64238, encryptionId=4ce26423802, topicName=水肿)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKCRibWHQArPHdSkqP90U1HwwqlGeU7BUgzY240D3v2ibBDJ09ybkGkwOjxz7qRmngZaGlK1taX6hfA/132, createdBy=2e772500094, createdName=小华子, createdTime=Sat Nov 06 08:26:26 CST 2021, time=2021-11-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1529539, encodeId=ceef15295390f, content=<a href='/topic/show?id=a02ce793707' target=_blank style='color:#2F92EE;'>#细胞毒性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77937, encryptionId=a02ce793707, topicName=细胞毒性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=10b211951227, createdName=appleandpeer, createdTime=Sat Nov 06 08:26:26 CST 2021, time=2021-11-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1067436, encodeId=ba5b106e436ee, content=厉害棒棒棒, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLWROGia7f3ficvom5MMQRnYVzLg9ibA7gJvvUeGDuylYP3de77n3NvQucKFsdz5F2npWEA3arQwxrKQ/132, createdBy=09ed2341770, createdName=心之方向, createdTime=Fri Nov 05 23:29:58 CST 2021, time=2021-11-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1067164, encodeId=870a106e16439, content=值得学习！, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211030/727082c36c794e7a9cc18aad6a2886d1/d8e51d61f5f74b299541d33450410b09.jpg, createdBy=26f72982264, createdName=海阔天空Sin, createdTime=Fri Nov 05 08:34:33 CST 2021, time=2021-11-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1067126, encodeId=101e106e1264c, content=默里大学下属的非营利组织DRIVE（Drug, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Fri Nov 05 06:00:36 CST 2021, time=2021-11-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1067099, encodeId=1f0e106e099dc, content=经典知识复习, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7e831560211, createdName=ZYY7209, createdTime=Thu Nov 04 23:15:08 CST 2021, time=2021-11-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1067055, encodeId=d05c106e0555f, content=厉害了，又学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=65aa5643711, createdName=小白努力长高高, createdTime=Thu Nov 04 21:30:22 CST 2021, time=2021-11-04, status=1, ipAttribution=)]
    2021-11-04 小白努力长高高

    厉害了，又学习了

    0

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