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Article(id=1322931628133196281, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322931549481599694, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.12.017, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1756569600000, receivedDateStr=2025-08-31, revisedDate=1780416000000, revisedDateStr=2026-06-03, acceptedDate=null, acceptedDateStr=null, onlineDate=1793341079028, onlineDateStr=2026-10-30, pubDate=1782316800000, pubDateStr=2026-06-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793341079028, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793341079028, creator=13701087609, updateTime=1793341079028, updator=13701087609, issue=Issue{id=1322931549481599694, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='12', pageStart='2001', pageEnd='2192', issueExtLink='null', onlineDate='null', pubDate='1782316800000', pubDateStr='2026-06-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793341060276, creator='13701087609', updateTime=1793343118019, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322940180335829530, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322931549481599694, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322940180335829531, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322931549481599694, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2129, endPage=2133, ext={EN=ArticleExt(id=1322931629953524219, articleId=1322931628133196281, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Preliminary exploration of the hierarchical medical system of patients with carotid atherosclerosis within the "generalist-specialist" collaborative management mode based on medical health alliance, columnId=1220689488284668633, journalTitle=Chinese Nursing Research, columnName=Comprehensive Study, runingTitle=null, highlight=null, articleAbstract=

This study explored the feasibility of establishing a "generalist-specialist" collaborative management model within the health alliance for hierarchical medical system of patients with carotid atherosclerosis.The main contents included joint outpatient services(general practitioners+neurologists),standardized carotid atherosclerosis screening(portable ultrasound and confirmatory carotid ultrasound),standardized referral pathways,and continuous general practitioner training.This management model could improve the efficiency of carotid atherosclerosis detection,optimize the allocation of medical resources through structured referrals,and enhance the professional ability of general practitioners in community stroke prevention.It provided practical reference for reducing the burden of stroke through hierarchical collaborative services.

, authors=Mengruo GUO1, Xiaoqian DONG1, Jinggang XUE1, Chunmei DING1, Lei FENG1, Yanying SHEN1, Shirong CHEN1, Yaping XIAO2, authorsList=Mengruo GUO, Xiaoqian DONG, Jinggang XUE, Chunmei DING, Lei FENG, Yanying SHEN, Shirong CHEN, Yaping XIAO, authorCompany=null, correspAuthors=Mengruo GUO, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322931630691721726, articleId=1322931628133196281, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=基于医联体“全科-专科”联合管理模式的颈动脉粥样硬化病人分级诊疗初步探索, columnId=1220689488938980091, journalTitle=护理研究, columnName=综合研究, runingTitle=null, highlight=null, articleAbstract=

探索在医联体内构建“全科-专科”联合管理模式对颈动脉粥样硬化病人分级诊疗的可行性，主要内容包括联合门诊（全科医生+神经科医生）、标准化颈动脉粥样硬化筛查（便携超声及确诊性颈动脉超声）、规范化转诊路径、持续性全生医师培训。该管理模式可提升颈动脉粥样硬化检出效率，通过结构化转诊优化了医疗资源配置，并增强全科医师在社区脑卒中预防中的专业能力，为通过分级协同服务降低脑卒中负担提供了实践参考。

, authors=郭梦若1, 董晓倩1, 薛静刚1, 丁春梅1, 封蕾1, 沈艳颖1, 陈史蓉1, 肖亚平2, authorsList=郭梦若, 董晓倩, 薛静刚, 丁春梅, 封蕾, 沈艳颖, 陈史蓉, 肖亚平, authorCompany=null, correspAuthors=郭梦若, authorNote=null, correspAuthorsNote=
GUO Mengruo， E-mail：
郭梦若，主治医师，硕士研究生，E-mail：
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language=EN, label=Figure 1, caption=Flowchart of the "generalist-specialist" combined management model for carotid atherosclerosis, figureFileSmall=y+pd9VU74Pjs8haNDbZNWw==, figureFileBig=bH7mtnoPqWuTN6jMSKe9SQ==, tableContent=null), ArticleFig(id=1322931636832182841, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322931628133196281, language=CN, label=图1, caption=颈动脉粥样硬化“全科-专科”联合管理模式流程图, figureFileSmall=y+pd9VU74Pjs8haNDbZNWw==, figureFileBig=bH7mtnoPqWuTN6jMSKe9SQ==, tableContent=null), ArticleFig(id=1322931637041898042, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322931628133196281, language=EN, label=Table 1, caption=

Visits to the combined neurological disease clinic from 2022 to 2025

, figureFileSmall=null, figureFileBig=null, tableContent=
年份总门诊人次联合门诊（人次）完善颈动脉超声（人次）
总计923 3626622 354
2022年202 342108462
2023年269 848173770
2024年277 796215651
2025年（上半年）173 376166471
), ArticleFig(id=1322931638711231035, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322931628133196281, language=CN, label=表1, caption=

2022—2025年脑血管病联合门诊就诊情况

, figureFileSmall=null, figureFileBig=null, tableContent=
年份总门诊人次联合门诊（人次）完善颈动脉超声（人次）
总计923 3626622 354
2022年202 342108462
2023年269 848173770
2024年277 796215651
2025年（上半年）173 376166471
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基于医联体“全科-专科”联合管理模式的颈动脉粥样硬化病人分级诊疗初步探索
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郭梦若 1 , 董晓倩 1 , 薛静刚 1 , 丁春梅 1 , 封蕾 1 , 沈艳颖 1 , 陈史蓉 1 , 肖亚平 2
护理研究 | 综合研究 2026,40(12): 2129-2133
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护理研究 |综合研究 2026 , 40 (12) : 2129 -2133
基于医联体“全科-专科”联合管理模式的颈动脉粥样硬化病人分级诊疗初步探索
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郭梦若1 , 董晓倩1, 薛静刚1, 丁春梅1, 封蕾1, 沈艳颖1, 陈史蓉1, 肖亚平2
作者信息
  • 1上海市浦东新区迎博社区卫生服务中心，上海 200125
  • 2同济大学附属东方医院
通讯作者:
GUO Mengruo， E-mail：
郭梦若，主治医师，硕士研究生，E-mail：
Preliminary exploration of the hierarchical medical system of patients with carotid atherosclerosis within the "generalist-specialist" collaborative management mode based on medical health alliance
Mengruo GUO1 , Xiaoqian DONG1, Jinggang XUE1, Chunmei DING1, Lei FENG1, Yanying SHEN1, Shirong CHEN1, Yaping XIAO2
Affiliations
  • 1Yingbo Community Health Service Center, Pudong New Area, Shanghai 200125 China
  • 2Shanghai East Hospital, Tongji University School of Medicine
出版时间: 2026-06-25 doi: 10.12102/j.issn.1009-6493.2026.12.017
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探索在医联体内构建“全科-专科”联合管理模式对颈动脉粥样硬化病人分级诊疗的可行性，主要内容包括联合门诊（全科医生+神经科医生）、标准化颈动脉粥样硬化筛查（便携超声及确诊性颈动脉超声）、规范化转诊路径、持续性全生医师培训。该管理模式可提升颈动脉粥样硬化检出效率，通过结构化转诊优化了医疗资源配置，并增强全科医师在社区脑卒中预防中的专业能力，为通过分级协同服务降低脑卒中负担提供了实践参考。

全科医学  /  医联体  /  颈动脉粥样硬化  /  分级诊疗  /  护理管理

This study explored the feasibility of establishing a "generalist-specialist" collaborative management model within the health alliance for hierarchical medical system of patients with carotid atherosclerosis.The main contents included joint outpatient services(general practitioners+neurologists),standardized carotid atherosclerosis screening(portable ultrasound and confirmatory carotid ultrasound),standardized referral pathways,and continuous general practitioner training.This management model could improve the efficiency of carotid atherosclerosis detection,optimize the allocation of medical resources through structured referrals,and enhance the professional ability of general practitioners in community stroke prevention.It provided practical reference for reducing the burden of stroke through hierarchical collaborative services.

general practice  /  health alliance  /  carotid atherosclerosis  /  hierarchical medical system  /  nursing management
郭梦若, 董晓倩, 薛静刚, 丁春梅, 封蕾, 沈艳颖, 陈史蓉, 肖亚平. 基于医联体“全科-专科”联合管理模式的颈动脉粥样硬化病人分级诊疗初步探索. 护理研究, 2026 , 40 (12) : 2129 -2133 . DOI: 10.12102/j.issn.1009-6493.2026.12.017
Mengruo GUO, Xiaoqian DONG, Jinggang XUE, Chunmei DING, Lei FENG, Yanying SHEN, Shirong CHEN, Yaping XIAO. Preliminary exploration of the hierarchical medical system of patients with carotid atherosclerosis within the "generalist-specialist" collaborative management mode based on medical health alliance[J]. Chinese Nursing Research, 2026 , 40 (12) : 2129 -2133 . DOI: 10.12102/j.issn.1009-6493.2026.12.017
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脑卒中是全球范围的重大公共卫生问题，2021年全球疾病负担（global burden of disease study,GBD）统计数据显示，我国脑卒中发病率、患病率、复发率高，且由于脑卒中致死、致残产生的经济负担呈现逐年上升趋势[1-2]。不仅严重影响病人的生命健康和生活质量，也为社会和家庭带来了沉重的负担[3-4]。颈动脉粥样硬化（carotid atherosclerosis,CAS）是通过进行性的脂质沉积、纤维组织增生及炎性细胞浸润等方式逐步侵蚀动脉血管，导致血管管壁增厚，弹性丧失。在此病理过程中，若不及时发现并进行干预，颈动脉粥样硬化继续进展，则会出现动脉狭窄、闭塞，最终导致缺血性脑卒中的发生，是缺血性脑卒中的重要危险因素之一[5]。2015年美国心脏协会公布的数据显示，颈动脉粥样硬化性狭窄导致的缺血性脑卒中占15%~20%[6]。颈动脉是动脉粥样硬化早期好发部位之一，且其颅外段位置表浅，方便探查，颈动脉粥样硬化是反映全身动脉粥样硬化的“窗口”。有研究纳入4 217名55岁以上的无症状老年受试者，平均随访5.2年，评估颈动脉斑块与脑卒中及脑梗死风险的相关性，结果提示颈动脉斑块可使老年人脑卒中和脑梗死风险增加约1.5倍[7]。因此，及时发现病人颈动脉粥样硬化的形成，并在病程早期进行正确干预对预防缺血性脑卒中具有重要意义[8-10]。
目前，颈动脉粥样硬化筛查及后期连续性健康管理的重要性越来越被社会认可，但结合当前我国的医疗现状，综合医院专科医生由于平日临床压力巨大，花费在慢性病管理上的时间、精力有限，非连续性的疾病管理并不能很好地控制病人慢性病的进展。社区卫生服务中心作为基层常见慢性病管理的主要场所，已成为政府和卫生服务领域的共识，但目前全科医生对专科疾病的系统诊治仍有不足，对专科疾病的管理和诊疗质量受到一定程度的影响，导致部分社区居民对基层医疗服务的信任度及满意度下降。因此，建立医联体内“全科-专科”联合管理模式，通过三级医院和社区卫生服务中心的联动合作，为病人提供便捷、专业且连续的慢性病管理服务十分重要。在联合管理模式建立及探索中，通过专科医生门诊跟诊、定期业务培训等途径，提高全科医生对动脉粥样硬化的识别及治疗能力，增加病人对基层医院就诊的信任感和满意度，更好地实现慢性病的分级诊疗，缓解上级医院的医疗压力，促成更加有序的就医格局[11-12]。本研究旨在通过构建一种医联体内颈动脉粥样硬化的“全科-专科”联合管理模式，并初步探讨其对颈动脉粥样硬化病人的可行性和初步管理效果。
1　医联体内颈动脉粥样硬化“全科-专科”联合管理模式的构建
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由迎博社区卫生服务中心与东方医院合作，依托“脑卒中专家工作站”在社区的影响力基础，在社区成立脑血管病“全科-专科”联合门诊。其中“全科”是指社区医院的全科医生及慢性病随访团队，“专科”是指医院神经内科专科医生，各有专长，优势互补，希望通过医联体内颈动脉粥样硬化“全科-专科”联合管理模式，培养社区脑血管病专病管理人才，规范分级诊疗流程，并将可实践的管理经验进行转化并推广，更有利于社区开展签约居民转诊工作，推行分级诊疗服务。
1.1　建立脑血管病“全科-专科”联合门诊
联合门诊时间为2周1次，由神经内科医生和全科医生共同出诊，以全科医生为主体，基于全科诊疗思维接诊病人，专科医生针对脑血管疾病的专科诊疗予以指导和建议，定期对全科医生进行业务培训和疑难病例讨论，促进专科医生与全科医生之间的学习交流。
1.2　高危病人筛查评估
设立颈动脉筛查慢性病助理，于每周固定时间对全科门诊预约的脑血管病高危病人进行颈动脉筛查，依托便携式超声仪进行颈动脉筛查等便捷手段，筛查出颈动脉粥样硬化疑似病人，再完善颈动脉血管超声检查，最终筛查出的颈动脉中重度狭窄及脑血管病高危病人可转诊至上级医院完善进一步检查。
1.3　分级诊疗标准和双向转诊流程的制定
经过医院神经内科专科医生和社区卫生服务中心的全科医生根据颈动脉筛查及颈动脉超声等影像学结果共同决策，共同制定颈动脉粥样硬化分级诊疗标准，明确全科医生及专科医生的分工，确定医联体间颈动脉粥样硬化病人的分级管理和医院间转诊流程，见图1。
1.4　转诊至专科进行颈动脉狭窄专科治疗
达到分级转诊标准、社区慢性病管理效果不理想的“1+1+1”签约病人，在经全科医生评估后，通过预约转诊平台转诊至上级专科完善颈动脉CT血管造影（CTA）、头颅磁共振成像（MRI）、头颅磁共振血管造影（MRA）等进一步检查后，有手术指征病人可优先收入专科病房进行专科相关诊治，签约居民通过社区转诊平台转诊可优先就诊、优先检查、优先住院。
1.5　后期社区随访及治疗
在经过病人同意后，慢性病助理员进行颈动脉筛查的同时收集病人一般资料及相关病史，定期对无专科手术指征病人和专科就诊后下转至社区的重点病人进行长期、连续的电话随访，督促其定期于全科医生和慢性病管理支持中心处就诊，保证后期治疗规范性，协助全科医生进行慢性病管理。
1.6　培训
1.6.1　社区全科医生培训
联合管理模式建立初期，医院神经内科专科医生定期对全科医生进行颈动脉粥样硬化相关诊疗指南等业务培训。后续随着合作的不断深入，建立医联体联合门诊工作微信群，并在线下通过继续教育课程项目和高峰论坛会议等形式，持续开展全科与各专科间的学术交流和科研合作。社区全科医生在病房及门诊如遇典型病例，进行院间会诊、教学查房和疑难病例讨论等。
1.6.2　社区居民健康教育
医联体医院在医师节、学雷锋日、世界脑卒中日等时间定期组织病人参加现场义诊等活动；社区医院在辖区居委定期组织健康知识讲座，科普宣传颈动脉粥样硬化等脑血管病相关健康管理知识，并分发颈动脉粥样硬化联合门诊宣传册，方便居民更好地根据自身身体情况自评，更有针对性地来社区完善颈动脉筛查。
2　“全科-专科”联合管理模式的初步成效
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脑血管病“全科-专科”联合门诊成立于2022年初，经过3年多时间的探索实践，目前已初步形成较为成熟的医联体内“全科-专科”联合管理模式。在中心每周1次的颈动脉筛查和每个月2次的脑血管病全科-专科联合门诊的服务和指导下，全科医生和病人对颈动脉粥样硬化及其导致的相关脑血管疾病的重视程度均有增加，并在联合门诊就诊人次、颈动脉筛查情况、药品配置及实验室检查的均质化、医联体间转诊情况等方面均有提升。2022年2月起，中心逐渐完善包括颅脑CT、便携式超声仪、颈动脉血管超声、心脏超声、血清胆固醇、血清低密度脂蛋白、同型半胱氨酸检测、D-二聚体、凝血功能等辅助检查和实验室检查，慢性病药品配置在用药目录范围内逐步与上级医院看齐，部分基层无法配置的药品种类，病人可进行家庭医生签约后通过延伸处方等途径满足转诊用药需求。
2022—2025年，脑血管病联合门诊持续实现服务扩容，诊疗人次从108人次（2022年）逐步提升至215人次（2024年），2025年上半年已达166人次。颈动脉超声筛查量相应从每年462人次（2022年）增至651人次（2024年），观察期内共累计完成2 354人次颈动脉超声检查，通过该标准化筛查流程共检出颈动脉狭窄人群62人次（检出率2.63%），其中37人次为需至上级医院进行专科就诊的颈动脉中-重度狭窄病人，占狭窄人群59.7%。2025年上半年筛查量（471人次）已超过2022年全年基线水平（462人次），见表1。
3　医联体内颈动脉粥样硬化“全科-专科”联合管理模式的思考
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目前，国际上很多国家和地区都在进行以全科医生为主体，通过团队分工合作，从而将全科与专科相结合的医疗服务模式[13-14]。例如美国全科医生可根据社区医疗需求开展皮肤科及精神卫生等相关专科服务[15]；英国政府在社区基础医疗站点开展多学科团队协作，支持慢性病病人实现自我照护[16]；还有些国家将专科团队引入全科诊所，直接为社区病人提供服务[17]。由于人口老龄化及疾病谱的不断改变[18-19],我国在分级诊疗上也在不断进行研究和尝试。2015年国务院办公厅印发了《关于推进分级诊疗制度建设的指导意见》[20]，标志着分级诊疗制度正式成为深化医改的重要课题。2016年国务院办公厅颁布的《“健康中国2030”规划纲要》[21]中提到，要建立专业公卫机构、综合和专科医院、基层医疗卫生机构“三位一体”的重大疾病防控机制。《关于推进医疗联合体建设和发展的指导意见》[22]指出，需建立规范的全专结合门诊制度体系，给予社区卫生机构相应的政策支持，加大力度支持社区发展全专结合门诊的人才培养、激励和使用。2020年，上海市卫生健康委员会印发的《上海市推进社区医院建设工作方案》[23]中提出，要推进基层医疗服务建设，强化社区卫生服务机构“全科-专科”联合管理的服务模式，在以全科为主要形式的基本诊疗服务的基础上，强化“全科专科结合”，提高基层医生专科专病诊疗服务能力。鼓励专家出诊、培训带教，从而促进医疗服务下沉基层。强化“全科专科结合”“医防融合”“中西结合”，推动构建整合、优质、高效的基层医疗卫生服务体系。结合上海市目前正在推行的“1+1+1”签约分级诊疗模式，医联体内“全科-专科”联合管理模式能够更好地实现医疗资源的联合、医疗标准及服务质量的连贯、病人健康信息的联通、改革政策的联动[24]，更好地实现基层颈动脉粥样硬化筛查及后期连续性健康管理，降低因颈动脉粥样硬化导致的缺血性脑卒中发病率，提高社区居民对基层医疗的信任度和满意度。
经过本研究的初步探索，认为基于医联体内“全科-专科”联合管理模式对颈动脉粥样硬化病人分级诊疗的管理模式更详细、精准地制定了颈动脉粥样硬化分级诊疗流程，明晰了该类病人在社区和专科诊疗中的不同分工，充分利用双向转诊平台和上级医院的专家资源，减少病人在就诊过程中的无效奔波，使医疗资源得到更加合理的配置。全科专科结合的管理模式使专科诊疗结合了全科诊疗思维中以病人为中心、以问题为导向、医患互动合作等特点[25],使得专科疾病得到更好的随访管理，进一步扩大医联体上级医院专病诊疗影响力的同时，提高病人满意度。同时，通过一系列临床及科研方面的继续教育培训，提升全科医生社区慢性疾病的专病的诊疗和管理能力，培养社区慢性病管理人才，提升社区诊疗能力的同时基层医生的职业获得感。
4　建议
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目前国内尚未制定全科专科联合门诊建设相关的具体规范和制度，在具体实施过程中仍存在些许问题，关于模式的构建有以下建议：1）在上海市卫生健康委员会的积极推动下，目前社区与上级医院间转诊服务一体化及检查检验结果互联互通互认已得到很好的实施[26]，但一些社区无法完善的检查（如CTA、MRI、MRA等），专科医生无法直接在社区进行开具，仍需通过转诊平台，由全科医师转诊至上级医院预约门诊号源后，到上级医院重新预约就诊，就诊流程仍有不便。希望后续可以部分开放上级医院相关检查预约，优化转诊流程，提高转诊效率。2）目前联合门诊主要以上级医院专科医生定期下社区，全科医生和专科医生共同出诊模式为主，但医联体不同机构间无统一排班及统一绩效管理，进行联合门诊的医生需个人协调工作时间且存在占用私人时间看诊的情况。负责联合门诊的全科医生和专科医生在工作量增加的同时并无相关绩效激励与制度倾斜，这导致部分医生动力不足，希望在后续医联体医院间可以对联合门诊政策和绩效方面有所激励，更加有利于后续医联体间联合门诊的推广与建设。
综上所述，尽管本模式目前存在些许问题，但仍然是未来推广的方向，颈动脉粥样硬化“全科-专科”联合管理模式为颈动脉粥样硬化病人的双向转诊及分级诊疗提供了良好的基础，在提高社区就诊能力的基础上增强医联体医院对于专病诊疗的影响力，后续实施效果仍需进一步调研进行验证。

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2026年第40卷第12期
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doi: 10.12102/j.issn.1009-6493.2026.12.017
  • 接收时间：2025-08-31
  • 首发时间：2026-10-30
  • 出版时间：2026-06-25
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  • 收稿日期：2025-08-31
  • 修回日期：2026-06-03
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    1上海市浦东新区迎博社区卫生服务中心，上海 200125
    2同济大学附属东方医院

通讯作者:

GUO Mengruo， E-mail：
郭梦若，主治医师，硕士研究生，E-mail：
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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