損傷機(jī)體的反應(yīng)課件

Inflammation白求恩醫(yī)學(xué)院病理學(xué)系李偉炎癥2010.09.29Inflammation白求恩醫(yī)學(xué)院病理學(xué)系炎癥2011損傷機(jī)體的反應(yīng)課件2禽流感病毒自身的特點(diǎn)，以及患者高達(dá)50％的死亡率，決定了它的殺傷力遠(yuǎn)遠(yuǎn)高于“非典”和艾滋病。禽流感病毒目前已經(jīng)在亞洲四個(gè)國(guó)家感染了一百多人，造成六十多人死亡。

禽流感病毒自身的特點(diǎn)，以及患者高達(dá)50％的死亡率，決定了它的3損傷機(jī)體的反應(yīng)課件4敵人入侵途徑

戰(zhàn)斗兵

傳令兵信號(hào)兵

傷亡人員戰(zhàn)爭(zhēng)的結(jié)果

致炎因子白細(xì)胞炎癥介質(zhì)炎性損傷炎癥是最常見(jiàn)的病理過(guò)程炎癥是最重要的保護(hù)性反應(yīng)炎癥對(duì)機(jī)體有不同程度的損害炎癥是損傷、抗損傷和修復(fù)的統(tǒng)一過(guò)程炎癥的結(jié)局?jǐn)橙巳肭滞緩街卵滓蜃影准?xì)胞炎癥介質(zhì)炎性損傷炎癥是最常見(jiàn)的病理5Inflammationisaprotectiveresponseofvascularizedlivingtissuestolocalinjury,leadingtotheaccumulationoffluidandleukocytesinextravasculartissues.炎癥inflammation炎癥是具有血管系統(tǒng)的活體組織對(duì)損傷因子所發(fā)生的復(fù)雜的防御反應(yīng)。血管反應(yīng)是炎癥過(guò)程的中心環(huán)節(jié)。液體滲出白細(xì)胞滲出和激活I(lǐng)nflammationisaprotectiver6草履蟲(chóng)草履蟲(chóng)7

炎癥的意義

損傷：損傷因子直接或間接損傷機(jī)體

抗損傷：炎癥充血和滲出稀釋、殺傷和包圍損傷因子。

修復(fù)：機(jī)體通過(guò)實(shí)質(zhì)和間質(zhì)細(xì)胞的再生使受損的組織得以修復(fù)和愈合

損傷抗損傷修復(fù)炎癥的意義：局限和消滅損傷因子，清除和吸收壞死組織和細(xì)胞，并通過(guò)實(shí)質(zhì)和間質(zhì)細(xì)胞的再生修復(fù)損傷。

炎癥的意義

損傷：損傷因子直接或間接損傷機(jī)體8營(yíng)養(yǎng)狀態(tài)免疫狀態(tài)內(nèi)分泌狀態(tài)炎癥對(duì)機(jī)體的影響性質(zhì)數(shù)量損傷持續(xù)的時(shí)間致炎因子—損傷機(jī)體的反應(yīng)—抗損傷

損傷與抗損傷斗爭(zhēng)結(jié)果既為炎癥的結(jié)局:

抗損傷>損傷→炎癥痊愈損傷>抗損傷→炎癥蔓延擴(kuò)散抗損傷=損傷→炎癥遷延不愈炎癥是人體內(nèi)的一場(chǎng)“戰(zhàn)爭(zhēng)”！

炎癥的意義

營(yíng)養(yǎng)狀態(tài)炎癥對(duì)機(jī)體的影響性質(zhì)致炎因子—損傷機(jī)體的反應(yīng)—抗91.任何能夠引起組織細(xì)胞損傷的因素均可引起炎癥3.基本病變有致炎因子導(dǎo)致的組織細(xì)胞變性壞死（變質(zhì)）,機(jī)體血管反應(yīng)（滲出液體和白細(xì)胞）局限殺滅損傷因子,局部組織細(xì)胞的增生，修復(fù)損傷組織2.本質(zhì)是致炎因子對(duì)機(jī)體的損傷與機(jī)體抗損傷反應(yīng)的矛盾斗爭(zhēng)過(guò)程4.損傷與抗損傷斗爭(zhēng)結(jié)果既為炎癥的結(jié)局:

抗損傷>損傷→炎癥痊愈損傷>抗損傷→炎癥蔓延擴(kuò)散抗損傷=損傷→炎癥遷延不愈HowcanweunderstandInflammation?1.任何能夠引起組織細(xì)胞損傷的因素均可引起炎癥3.基本10Causes-1Infectionsandmicrobetoxins(Biologicalfactor):

Viruses,bacteria,fungi,protozoa,etc.

Viruses---cellularnecrosisBacteria---releasingtoxinAllergy炎癥inflammationCauses-1Infectionsandmicrob11Causes-2Physicalagents:trauma,excessiveheatorcold,radiantray,etc.炎癥inflammationCauses-2Physicalagents:trau12Causes-3Chemicalagents：

exogenoussubstancesendogenoussubstancesMicrobiologicagents:Necrosistissue炎癥inflammationCauses-3Chemicalagents：exo13Causes-4Allergyorabnormalimmunologicreaction

Necrosistissue炎癥inflammationCauses-5Causes-4Allergyorabnormalim14

redness(rubor)紅

swelling(tumor)腫

heat(calor)熱pain(dolor)痛

lossoffunction功能障礙ThecardinalsignsofinflammationSection1炎癥inflammationredness(rubor)紅Thecardina15HeatRednessSwellingPainLossOfFunction炎癥inflammationHeatRednessSw16Thearmatthebottomisswollen(edematous)andreddened(erythematous)comparedtothearmatthetop.

Thecardinalsignsofinflammation炎癥inflammationThearmatthebottomisswoll17發(fā)熱Fever外周血白細(xì)胞計(jì)數(shù)增高Leukocytosis：15000-20000/mm3急性期反應(yīng)蛋白合成增多synthesisofavarietyofproteins慢波睡眠增加increasedsomnolence厭食anorexia全身不適malaise肌肉蛋白降解加速accelerateddegradationofskeletalmuscleproteinsacuteinflammationheremarkedbyanincreaseinsegmentedneutrophils(PMN's)“Left-shift”TheSystemicsignsofinflammation--急性期反應(yīng)Acutephasereaction

炎癥inflammation發(fā)熱Feveracuteinflammationhere18致炎因子組織細(xì)胞變性壞死變質(zhì)Alteration血管反應(yīng)消滅和局限損傷因子滲出Exudation組織細(xì)胞的增生修復(fù)損傷增生Proliferation炎癥inflammationBasicmorphologicalchangesofinflammation致炎因子組織細(xì)胞變性壞死變質(zhì)血管反應(yīng)滲出組織細(xì)胞的增生增生炎19Alteration變質(zhì):degenerationandnecrosis

炎癥局部組織發(fā)生的變性和壞死致病因子的性質(zhì)和強(qiáng)度機(jī)體的反應(yīng)性原因與機(jī)制致病因子直接作用血液循環(huán)障礙炎癥反應(yīng)產(chǎn)物的間接作用免疫機(jī)制形態(tài)實(shí)質(zhì):水腫，脂肪變性，凝固性壞死，液化性壞死間質(zhì):粘液變性和纖維素樣壞死BasicmorphologicalchangesofinflammationAlteration變質(zhì):degenerationand20Basicmorphologicalchangesofinflammation腎小管上皮細(xì)胞水腫、玻變肝脂肪變性Basicmorphologicalchangesof21Basicmorphologicalchangesofinflammation肝溶解性壞死肺碎片狀壞死Basicmorphologicalchangesof22下肢壞疽Basicmorphologicalchangesofinflammation下肢壞疽Basicmorphologicalchange23Exudation炎性滲出Theescapeoffluid,proteins,andbloodcellsfromvascularsystemintotheinterstitialtissueorbodycavities.滲出：炎癥局部組織血管內(nèi)的液體成分、纖維素等蛋白質(zhì)和各種炎癥細(xì)胞通過(guò)血管壁進(jìn)入組織、體腔、體表和粘膜表面的過(guò)程。白細(xì)胞、抗體輸送到炎癥灶，發(fā)揮防御作用

Basicmorphologicalchangesofinflammation滲出Exudation炎性水腫inflammatoryedema炎性積液inflammatory

hydrops---是炎癥最具特征性的變化Exudation炎性滲出Theescapeofflu24ExudationBasicmorphologicalchangesofinflammationExudationBasicmorphologicalc25ExudationBasicmorphologicalchangesofinflammationExudationBasicmorphologicalc26ExudationBasicmorphologicalchangesofinflammationExudationBasicmorphologicalc27ExudationBasicmorphologicalchangesofinflammationExudationBasicmorphologicalc28滲出液(exudate)和漏出液(transudate)的比較

漏出液滲出液血管通透性正常增加蛋白質(zhì)含量0-1.5g/dl1.5-6g/dl蛋白質(zhì)類(lèi)型白蛋白白蛋白、球蛋白、補(bǔ)體、免疫球蛋白纖維素?zé)o有比

重<1.018>1.018細(xì)胞數(shù)<0.1*109/L>0.5*109/L滲出液(exudate)和漏出液(transudate)的比29proliferation-增生

parenchymalcells－epithelialcells,glandsInterstitialcells--macrophages,endothelialcells,fibroblastsLimitinflammatorydiffusionandrepairBasicmorphologicalchangesofinflammation---炎癥的修復(fù)過(guò)程

proliferation-增生parenchymal30某一種炎癥性疾病的局部病變往往以其中一種病變?yōu)橹?。病毒性肝炎—以變質(zhì)為主化膿性炎癥—以滲出為主急性腎炎—以增生為主三者可相互轉(zhuǎn)化，如結(jié)核一般而言，病變?cè)缙冢毙匝装Y）往往以變質(zhì)、滲出為主，如急性肝炎，急性細(xì)菌性痢疾；病變后期（慢性炎癥）多以增生為主，如慢性肝炎，慢性肉芽腫性炎。對(duì)機(jī)體而言，變質(zhì)是一種損傷過(guò)程，滲出、增生是抗損傷過(guò)程Basicmorphologicalchangesofinflammation某一種炎癥性疾病的局部病變往往以其中一種病變?yōu)橹鳌asic31acuteinflammationchronicinflammationproliferationnotissuelossresolutionexcessiveexudatesuppurationexcessivenecrosisrepairandorganizationdischargeofpusfibrosistissuedestructionremodellingacuteinflammationchronicinfl32炎癥的類(lèi)型根據(jù)病程經(jīng)過(guò)分為兩大類(lèi)：急性炎癥：持續(xù)時(shí)間短，數(shù)天至一個(gè)月，以滲出性病變?yōu)橹鳎装Y細(xì)胞浸潤(rùn)以中性粒細(xì)胞為主。慢性炎癥：持續(xù)時(shí)間較長(zhǎng)，數(shù)月到數(shù)年，病變以增生性變化為主，炎癥細(xì)胞浸潤(rùn)以淋巴細(xì)胞和單核細(xì)胞為主。炎癥的臨床類(lèi)型：超急性炎癥：數(shù)小時(shí)至數(shù)天急性炎癥:數(shù)天至一個(gè)月，以變質(zhì)和滲出為主慢性炎癥:數(shù)月至數(shù)年，以增生為主亞急性炎癥:一個(gè)月至數(shù)月炎癥的類(lèi)型根據(jù)病程經(jīng)過(guò)分為兩大類(lèi)：炎癥的臨床類(lèi)型：33Section2

acuteinflammationSection2

acuteinflammation34Majoreventsinacuteinflammationhemodynamicchangesincreasedvascularpermeability

Cellularresponse

leukocyteexudation

VasculareventsFluidexudation

phagocytosis

tissueinjuryMajoreventsinacuteinflamma35Themajorlocalmanifestationsofacuteinflammation:(1)vasculardilation;(2)extravasationofplasmafluidandprotein;(3)leukocyteemigrationandaccumulationinthesiteofinjury(1)vasculardilation(2)extravasationofplasmafluidandprotein

(3)leukocyteemigrationandaccumulationinthesiteofinjuryThemajorlocalmanifestationsofacuteinflammation:Themajorlocalmanifestations36Persistentvasodilatation1.Hemodynamicchanges(vascularresponse)Slowing(congestionandedema)TransientarteriolarcontractionInitiallyrapid(activehyperemia)StasisLeucocytesexudateRBCtransudateChangesinbloodflowPersistentvasodilatation1.He37HemodynamicchangesHemodynamicchanges381.Hemodynamicchanges1.Hemodynamicchanges391.HemodynamicchangesThedurationofhemodynamicchangesdependsonthetypesofinjuryagentsandthedegreeofinjure.Slightstimuli---rapidflow10-15min--normalLightstimuli—hoursofrapidflow---slowdown—stasisHeavystimuli---stasisin15-30minSevereinjury—satsisinminutes1.HemodynamicchangesThedura402.Increasedvascularpermeability

Directendothelialinjury

內(nèi)皮細(xì)胞損傷Dependsontheintegrityofendothelialcells

Endothelialcellcontraction---immediatetransientresponse

速發(fā)短暫反應(yīng)Increasedtranscytosis穿胞作用增強(qiáng)Endothelialinjurymediatedbyleukocytes2.Increasedvascularpermeabi41outpouringoffluid2.Increasedvascularpermeability炎性水腫Inflammatoryedema

：在炎癥過(guò)程中富含蛋白質(zhì)的液體滲出到血管外，聚集在組織內(nèi)稱(chēng)為炎性水腫炎性積液Inflammatoryhydrous

：如富含蛋白質(zhì)的液體聚集于漿膜腔，則稱(chēng)為漿膜腔炎性積液。Inflammatoryedemaoutpouringoffluid2.Increase42SignificanceofinflammatoryexudationDilutetoxinBringnutritionmaterialandcarryoutmetabolizedproductAntibodies,complementsystemFibrinspreventmicrobespreadingStimulatecellimmunityandhumoralimmunityadvantagesSignificanceofinflammatorye43disadvantagesImpairwoundhealingcompressandobstruction

Severeexudationinimportantorgansmay

evencausedeathOrganizationmaycausecarnificationSignificanceofinflammatoryexudationdisadvantagesImpairwoundhea44FluidexudateFluidexudate45Majoreventsinacuteinflammationhemodynamicchangesincreasedvascularpermeability

Cellularresponse

leukocyteexudation

VasculareventsFluidexudation

phagocytosis

tissueinjuryMajoreventsinacuteinflamma46白細(xì)胞從血管內(nèi)穿過(guò)管壁到達(dá)損傷部位的過(guò)程為白細(xì)胞滲出(Leucocyteexudation)白細(xì)胞出現(xiàn)在局部組織間隙的現(xiàn)象稱(chēng)為炎細(xì)胞浸潤(rùn)(inflammatorycellsinfiltration)是炎癥防御反應(yīng)的最重要形態(tài)學(xué)特征。白細(xì)胞滲出和吞噬作用Leucocyteexudationandphagocytosis白細(xì)胞從血管內(nèi)穿過(guò)管壁到達(dá)損傷部位的過(guò)程為白細(xì)胞滲出(Leu47LeukocyteexudationLeukocytemarginationandrollingCentralaxialstreamSelectin(E,PandL)Leukocyteadhesionintercellularadhesionmolecule-1(ICAM-1)vascularcelladhesionmolecule-1(VCAM-1)EmigrationandchemotaxisLeukocyteexudationLeukocytem48SequenceofleukocyticeventininflammationSequenceofleukocyticeventi49HemodynamicchangesHemodynamicchanges50TypesofCellsinvolvedNeutrophilicleukocyte(中性粒細(xì)胞）(first24hours)

Mononuclearcell,macrophage（巨噬細(xì)胞）(afterfirst24-48h)

Lymphocytes（淋巴細(xì)胞）Eosinophilicleukocyte（噬酸性粒細(xì)胞）

Basophilicleukocyte（嗜堿性粒細(xì)胞）TypesofCellsinvolvedNeutrop51損傷機(jī)體的反應(yīng)課件52Inflammation白求恩醫(yī)學(xué)院病理學(xué)系李偉炎癥2010.09.29Inflammation白求恩醫(yī)學(xué)院病理學(xué)系炎癥20153損傷機(jī)體的反應(yīng)課件54禽流感病毒自身的特點(diǎn)，以及患者高達(dá)50％的死亡率，決定了它的殺傷力遠(yuǎn)遠(yuǎn)高于“非典”和艾滋病。禽流感病毒目前已經(jīng)在亞洲四個(gè)國(guó)家感染了一百多人，造成六十多人死亡。

禽流感病毒自身的特點(diǎn)，以及患者高達(dá)50％的死亡率，決定了它的55損傷機(jī)體的反應(yīng)課件56敵人入侵途徑

戰(zhàn)斗兵

傳令兵信號(hào)兵

傷亡人員戰(zhàn)爭(zhēng)的結(jié)果

致炎因子白細(xì)胞炎癥介質(zhì)炎性損傷炎癥是最常見(jiàn)的病理過(guò)程炎癥是最重要的保護(hù)性反應(yīng)炎癥對(duì)機(jī)體有不同程度的損害炎癥是損傷、抗損傷和修復(fù)的統(tǒng)一過(guò)程炎癥的結(jié)局?jǐn)橙巳肭滞緩街卵滓蜃影准?xì)胞炎癥介質(zhì)炎性損傷炎癥是最常見(jiàn)的病理57Inflammationisaprotectiveresponseofvascularizedlivingtissuestolocalinjury,leadingtotheaccumulationoffluidandleukocytesinextravasculartissues.炎癥inflammation炎癥是具有血管系統(tǒng)的活體組織對(duì)損傷因子所發(fā)生的復(fù)雜的防御反應(yīng)。血管反應(yīng)是炎癥過(guò)程的中心環(huán)節(jié)。液體滲出白細(xì)胞滲出和激活I(lǐng)nflammationisaprotectiver58草履蟲(chóng)草履蟲(chóng)59

炎癥的意義

損傷：損傷因子直接或間接損傷機(jī)體

抗損傷：炎癥充血和滲出稀釋、殺傷和包圍損傷因子。

修復(fù)：機(jī)體通過(guò)實(shí)質(zhì)和間質(zhì)細(xì)胞的再生使受損的組織得以修復(fù)和愈合

損傷抗損傷修復(fù)炎癥的意義：局限和消滅損傷因子，清除和吸收壞死組織和細(xì)胞，并通過(guò)實(shí)質(zhì)和間質(zhì)細(xì)胞的再生修復(fù)損傷。

炎癥的意義

損傷：損傷因子直接或間接損傷機(jī)體60營(yíng)養(yǎng)狀態(tài)免疫狀態(tài)內(nèi)分泌狀態(tài)炎癥對(duì)機(jī)體的影響性質(zhì)數(shù)量損傷持續(xù)的時(shí)間致炎因子—損傷機(jī)體的反應(yīng)—抗損傷

損傷與抗損傷斗爭(zhēng)結(jié)果既為炎癥的結(jié)局:

抗損傷>損傷→炎癥痊愈損傷>抗損傷→炎癥蔓延擴(kuò)散抗損傷=損傷→炎癥遷延不愈炎癥是人體內(nèi)的一場(chǎng)“戰(zhàn)爭(zhēng)”！

炎癥的意義

營(yíng)養(yǎng)狀態(tài)炎癥對(duì)機(jī)體的影響性質(zhì)致炎因子—損傷機(jī)體的反應(yīng)—抗611.任何能夠引起組織細(xì)胞損傷的因素均可引起炎癥3.基本病變有致炎因子導(dǎo)致的組織細(xì)胞變性壞死（變質(zhì)）,機(jī)體血管反應(yīng)（滲出液體和白細(xì)胞）局限殺滅損傷因子,局部組織細(xì)胞的增生，修復(fù)損傷組織2.本質(zhì)是致炎因子對(duì)機(jī)體的損傷與機(jī)體抗損傷反應(yīng)的矛盾斗爭(zhēng)過(guò)程4.損傷與抗損傷斗爭(zhēng)結(jié)果既為炎癥的結(jié)局:

抗損傷>損傷→炎癥痊愈損傷>抗損傷→炎癥蔓延擴(kuò)散抗損傷=損傷→炎癥遷延不愈HowcanweunderstandInflammation?1.任何能夠引起組織細(xì)胞損傷的因素均可引起炎癥3.基本62Causes-1Infectionsandmicrobetoxins(Biologicalfactor):

Viruses,bacteria,fungi,protozoa,etc.

Viruses---cellularnecrosisBacteria---releasingtoxinAllergy炎癥inflammationCauses-1Infectionsandmicrob63Causes-2Physicalagents:trauma,excessiveheatorcold,radiantray,etc.炎癥inflammationCauses-2Physicalagents:trau64Causes-3Chemicalagents：

exogenoussubstancesendogenoussubstancesMicrobiologicagents:Necrosistissue炎癥inflammationCauses-3Chemicalagents：exo65Causes-4Allergyorabnormalimmunologicreaction

Necrosistissue炎癥inflammationCauses-5Causes-4Allergyorabnormalim66

redness(rubor)紅

swelling(tumor)腫

heat(calor)熱pain(dolor)痛

lossoffunction功能障礙ThecardinalsignsofinflammationSection1炎癥inflammationredness(rubor)紅Thecardina67HeatRednessSwellingPainLossOfFunction炎癥inflammationHeatRednessSw68Thearmatthebottomisswollen(edematous)andreddened(erythematous)comparedtothearmatthetop.

Thecardinalsignsofinflammation炎癥inflammationThearmatthebottomisswoll69發(fā)熱Fever外周血白細(xì)胞計(jì)數(shù)增高Leukocytosis：15000-20000/mm3急性期反應(yīng)蛋白合成增多synthesisofavarietyofproteins慢波睡眠增加increasedsomnolence厭食anorexia全身不適malaise肌肉蛋白降解加速accelerateddegradationofskeletalmuscleproteinsacuteinflammationheremarkedbyanincreaseinsegmentedneutrophils(PMN's)“Left-shift”TheSystemicsignsofinflammation--急性期反應(yīng)Acutephasereaction

炎癥inflammation發(fā)熱Feveracuteinflammationhere70致炎因子組織細(xì)胞變性壞死變質(zhì)Alteration血管反應(yīng)消滅和局限損傷因子滲出Exudation組織細(xì)胞的增生修復(fù)損傷增生Proliferation炎癥inflammationBasicmorphologicalchangesofinflammation致炎因子組織細(xì)胞變性壞死變質(zhì)血管反應(yīng)滲出組織細(xì)胞的增生增生炎71Alteration變質(zhì):degenerationandnecrosis

炎癥局部組織發(fā)生的變性和壞死致病因子的性質(zhì)和強(qiáng)度機(jī)體的反應(yīng)性原因與機(jī)制致病因子直接作用血液循環(huán)障礙炎癥反應(yīng)產(chǎn)物的間接作用免疫機(jī)制形態(tài)實(shí)質(zhì):水腫，脂肪變性，凝固性壞死，液化性壞死間質(zhì):粘液變性和纖維素樣壞死BasicmorphologicalchangesofinflammationAlteration變質(zhì):degenerationand72Basicmorphologicalchangesofinflammation腎小管上皮細(xì)胞水腫、玻變肝脂肪變性Basicmorphologicalchangesof73Basicmorphologicalchangesofinflammation肝溶解性壞死肺碎片狀壞死Basicmorphologicalchangesof74下肢壞疽Basicmorphologicalchangesofinflammation下肢壞疽Basicmorphologicalchange75Exudation炎性滲出Theescapeoffluid,proteins,andbloodcellsfromvascularsystemintotheinterstitialtissueorbodycavities.滲出：炎癥局部組織血管內(nèi)的液體成分、纖維素等蛋白質(zhì)和各種炎癥細(xì)胞通過(guò)血管壁進(jìn)入組織、體腔、體表和粘膜表面的過(guò)程。白細(xì)胞、抗體輸送到炎癥灶，發(fā)揮防御作用

Basicmorphologicalchangesofinflammation滲出Exudation炎性水腫inflammatoryedema炎性積液inflammatory

hydrops---是炎癥最具特征性的變化Exudation炎性滲出Theescapeofflu76ExudationBasicmorphologicalchangesofinflammationExudationBasicmorphologicalc77ExudationBasicmorphologicalchangesofinflammationExudationBasicmorphologicalc78ExudationBasicmorphologicalchangesofinflammationExudationBasicmorphologicalc79ExudationBasicmorphologicalchangesofinflammationExudationBasicmorphologicalc80滲出液(exudate)和漏出液(transudate)的比較

漏出液滲出液血管通透性正常增加蛋白質(zhì)含量0-1.5g/dl1.5-6g/dl蛋白質(zhì)類(lèi)型白蛋白白蛋白、球蛋白、補(bǔ)體、免疫球蛋白纖維素?zé)o有比

重<1.018>1.018細(xì)胞數(shù)<0.1*109/L>0.5*109/L滲出液(exudate)和漏出液(transudate)的比81proliferation-增生

parenchymalcells－epithelialcells,glandsInterstitialcells--macrophages,endothelialcells,fibroblastsLimitinflammatorydiffusionandrepairBasicmorphologicalchangesofinflammation---炎癥的修復(fù)過(guò)程

proliferation-增生parenchymal82某一種炎癥性疾病的局部病變往往以其中一種病變?yōu)橹?。病毒性肝炎—以變質(zhì)為主化膿性炎癥—以滲出為主急性腎炎—以增生為主三者可相互轉(zhuǎn)化，如結(jié)核一般而言，病變?cè)缙冢毙匝装Y）往往以變質(zhì)、滲出為主，如急性肝炎，急性細(xì)菌性痢疾；病變后期（慢性炎癥）多以增生為主，如慢性肝炎，慢性肉芽腫性炎。對(duì)機(jī)體而言，變質(zhì)是一種損傷過(guò)程，滲出、增生是抗損傷過(guò)程Basicmorphologicalchangesofinflammation某一種炎癥性疾病的局部病變往往以其中一種病變?yōu)橹?。Basic83acuteinflammationchronicinflammationproliferationnotissuelossresolutionexcessiveexudatesuppurationexcessivenecrosisrepairandorganizationdischargeofpusfibrosistissuedestructionremodellingacuteinflammationchronicinfl84炎癥的類(lèi)型根據(jù)病程經(jīng)過(guò)分為兩大類(lèi)：急性炎癥：持續(xù)時(shí)間短，數(shù)天至一個(gè)月，以滲出性病變?yōu)橹鳎装Y細(xì)胞浸潤(rùn)以中性粒細(xì)胞為主。慢性炎癥：持續(xù)時(shí)間較長(zhǎng)，數(shù)月到數(shù)年，病變以增生性變化為主，炎癥細(xì)胞浸潤(rùn)以淋巴細(xì)胞和單核細(xì)胞為主。炎癥的臨床類(lèi)型：超急性炎癥：數(shù)小時(shí)至數(shù)天急性炎癥:數(shù)天至一個(gè)月，以變質(zhì)和滲出為主慢性炎癥:數(shù)月至數(shù)年，以增生為主亞急性炎癥:一個(gè)月至數(shù)月炎癥的類(lèi)型根據(jù)病程經(jīng)過(guò)分為兩大類(lèi)：炎癥的臨床類(lèi)型：85Section2

acuteinflammationSection2

acuteinflammation86Majoreventsinacuteinflammationhemodynamicchangesincreasedvascularpermeability

Cellularresponse

leukocyteexudation

VasculareventsFluidexudation

phagocytosis

tissueinjuryMajoreventsinacuteinflamma87Themajorlocalmanifestationsofacuteinflammation:(1)vasculardilation;(2)extravasationofplasmafluidandprotein;(3)leukocyteemigrationandaccumulationinthesiteofinjury(1)vasculardilation(2)extravasationofplasmafluidandprotein

(3)leukocyteemigrationandaccumulationinthesiteofinjuryThemajorlocalmanifestationsofacuteinflammation:Themajorlocalmanifestations88Persistentvasodilatation1.Hemodynamicchanges(vascularresponse)Slowing(congestionandedema)TransientarteriolarcontractionInitiallyrapid(activehyperemia)StasisLeucocytesexudateRBCtransudateChangesinbloodflowPersistentvasodilatation1.He89HemodynamicchangesHemodynamicchanges901.Hemodynamicchanges1.Hemodynamicchanges911.HemodynamicchangesThedurationofhemodynamicchangesdependsonthetypesofinjuryagentsandthedegreeofinjure.Slightstimuli---rapidflow10-15min--normalLightstimuli—hoursofrapidflow---slowdown—stasisHeavystimuli---stasisin15-30minSevereinjury—satsisinminutes1.HemodynamicchangesThedura922.Increasedvascularpermeability

Directendothelialinjury

內(nèi)皮細(xì)胞損傷Dependsontheintegrityofendothelialcells

Endothelialcellcontraction---immediatetransientresponse

速發(fā)短暫反應(yīng)Increasedtranscytosis穿胞作用增強(qiáng)Endothelialinjurymediatedbyleukocytes2.Increasedvascularpermeabi93outpouring