南方医科大学呼吸系统疾病612肺炎课件

Department of Pathology Southern Medical University,呼吸系统疾病（二） Respiratory System Disease,梁 莉,Types of respiratory system disease,Chronic Obstructive Pulmonary Disease (COPD) 慢性支气管炎 Chronic bronchitis 肺气肿 Pulmonary emphysema 支气管扩张症 Bronchiectasis Pneumonia 大叶性肺炎 Lobar pneumonia 小叶性肺炎 Lobular pneumonia 病毒性肺炎 Viral pneumonia Severe Acute Respiratory Syndrome(SARS) Chronic cor pulmonale Pneumoconiosis Tumors of respiratory system,Pneumonia,- 急性渗出性炎症,75.5% of acute infective death ratio of respiratory system,5th in various types of death etiology,Types of pneumonia,Etiology Place and slope Character,Biological factors: Bacterial, Viral, Mycoplasmal,Physical and chemical factors:,Lobar pneumonia,Lobular pneumonia,Interstitial pneumonia,Segmental pneumonia,Lobar pneumonia,Introduction Etiology&Pathogenesis Pathological changes Clinical relations,肺泡内弥漫性纤维素性炎症 青壮年 临床表现: 起病急，寒战，高热，胸痛，咳嗽，铁锈色痰，呼吸困难，肺实变，WBC 疾病自然发展史: 5-10天,Introduction,浆 液 性 渗 出 物,细菌在肺泡中繁殖,肺泡孔,呼吸细支气管,带菌渗出液,大叶间蔓延,叶支气管,邻近肺组织,机体抵抗力呼吸道防御能力细菌感染(肺炎球菌) 变态反应性炎血管扩张，通透性浆液、纤维素渗出,肺炎链球菌（1,2,3,7型）,金黄色葡萄球菌,溶血性链球菌,90,Etiology & Pathogenesis,多为单侧肺，左肺或右肺下叶 常累及两个以上肺叶 四个阶段，5-10天,Pathological changes ,一、充血水肿期（12天） ,肉眼：肿大 重量增加 暗红 镜下：肺泡壁毛细血管扩张、充血 肺泡腔大量浆液,少红、中性粒、巨 噬细胞,大量细菌,高热、咳嗽，毒血症 湿性啰音、淡薄阴影,二、红色肝样变期（34天） ,肉眼：大、质实、灰红 镜下：肺泡壁毛细血管扩张充血，肺泡腔 大量RBC渗出，少数WBC、纤维素,发绀、咳嗽、铁锈色痰、胸痛、支气管呼吸音、湿性罗音、致密阴影,This stage is referred to as “Red hepatization” in lobar pneumonia. The alveoli contain more red cells and serum and less neutrophils. Arterioles and capillaries are highly congested.,三、灰色肝样变期(5-6天) ,肉眼：大、重量、灰白、实 镜下：肺泡腔 纤维蛋白渗出 中性粒细胞 纤维素连成网、少细菌 肺泡壁 毛细血管受压,Typical appearance of right lobar Pneumonia,发绀、咳脓痰、胸痛 大片致密阴影,Third stage of pneumonia “Gray hepatization”. Alveoli are filled with more fibrin and neutrophils. The congestion of vessels is receding.,四、溶解消散期（一周左右） ,肉眼：质软 镜下：白细胞变性坏死蛋白溶解酶 纤维素溶解咳出、淋巴管吸收,体温降、痰多、捻发音 阴影渐退消失,Fouth stage of pneumonia “Resolution”,Four stages (5-10 days),Lobar pneumonia,Outcome and complication,败血症，感染性休克 （休克/中毒型肺炎）,肺肉质变,多数可恢复正常,纤维素性胸膜炎 肺脓肿、脓胸,病灶,侵犯胸膜,金葡菌,细菌入血,肺脓肿：当机体抵抗力低，合并其它细菌感染时，肺组织可坏死而形成脓肿,Lobular pneumonia,Introduction Etiology&Pathogenesis Pathological changes Clinical relations,& 急性化脓性炎症 & 常局限于细支气管及其周围，又称作支气管 肺炎 & 婴幼儿，老人 & 常是其它疾病的合并症,Introduction,Etiology : many kinds of bacteria mixed infection Pathogenesis: Defense of airway Induced factorsbody resistancebacteria proliferation Bronchitis Lobular pneumonia,Pathological changes ,肉眼：大小不等、0.5-1cm、不规则、灰黄； 散布两肺各叶，以下叶和背侧多见； 可融合（融合性支气管肺炎）,Confluent lobular pneumonia,镜下: 细支气管粘膜充血、水肿，上皮坏死、脱落，腔内大量脓性渗出 周围肺泡壁血管扩张充血，肺泡腔脓性渗 出，代偿肺气肿、肺不张,Low power view shows patchy peribronchiolar distribution of pneumonia,Acute purulent exudate fills bronchioles and adjacent alveoli.,White cell-,-Bacterial cenobium,Clinical relations,临床表现：咳嗽、发热、咳痰、胸痛 无明显肺实变 湿啰音 X ray,Outcome and complication,呼吸衰竭 心脏衰竭 肺脓肿, 脓胸 支气管扩张 脓毒败血症,Viral pneumonia,常见病毒: flu virus, adenovirus, syncytial virus, measles virus, cytomegalovirus 临床表现: 儿童，多样性，毒血症顽固性 咳嗽或气促,Pathological changes,肉眼：病变不明显、轻度增大 镜下：间质性肺炎 间质 充血、水肿 淋巴细胞、单核细胞浸润 肺泡间隔明显增宽 肺泡腔 无或少量浆液,Interstitial pneumonitis with alveolar walls widened by mononuclear cells, but no intra-alveolar exudate,透明膜：流感、麻疹、腺病毒肺炎,多核巨细胞：麻疹病毒（支气管、肺泡上皮增生）,病毒包涵体：圆形、红细胞大、嗜酸、透明晕 腺、单纯疱疹、巨细胞病毒核内 呼吸道合胞病毒浆内 麻疹病毒核及浆内 -重要诊断依据,Synceytial cell pneumonia,Severe Acute Respiratory syndrome, SARS 2003-3-15 WHO,SARS is a viral respiratory illness caused by a coronavirus, that has not previously affected humans. SARS was first reported in Asia in February 2003. The SARS global outbreak of 2003 was contained; however, it is possible that the disease could re-emerge.,肉眼：肿，实，点状坏死、梗死 镜下：透明膜、胞浆病 毒包涵体，肺泡浆液纤 维素、中性粒细胞，小 血管内微