第四章 组织病理学基础-炎症简要版 (课堂PPT)

DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,第四章组织病理学基础第二节炎症,绍兴文理学院医学院病理学教研室张巧英,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,知识框架,概述炎症局部的基本病理变化炎症的类型及病理变化特点炎症的局部表现和全身反应炎症的临床分型和结局,知识目标,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,一、概述,具有血管系统的活体组织对致炎因子所致局部损害而发生的以防御为主的反应。致炎因子？最常见的致炎因子？感染？,什么是炎症？,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,致炎因子引起损伤性变化血管反应（血管扩张血浆及白细胞渗出局限和消灭损伤因子，清除和吸收坏死组织和细胞）实质细胞和间质细胞再生修复损伤血管反应是炎症过程的中心环节,变质,增生,炎症过程,炎症反应是如何发生的？,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,早期,变质渗出增生,损伤性反应,防御性反应,晚期,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,炎症介质(inflammatorymediator),定义：一组参与并诱导炎症发生发展的具有生物活性的化学物质作用：1、促进血管反应，使血管壁通透性增高2、对炎细胞的趋化作用3、引起发热、疼痛等,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,炎症是机体的一种（）免疫反应局部反应全身性反应防御性反应细菌或病毒反应,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,炎症过程的中心环节是（）A细胞和组织的各种损伤B白细胞对损伤因子的吞噬作用C血管反应D修复损伤E实质细胞和间质细胞增生,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,炎症最常见的病因是（）A物理性因子B化学性因子C坏死组织D生物性因子E变态反应,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,二、炎症局部的基本病理变化,变质(alteration):炎症局部组织或细胞发生变性和坏死。促进渗出发生。渗出(exudation):炎症灶血管内的液体和细胞成分通过血管壁进入组织间隙、体腔、体表和粘膜表面的过程。增生(proliferation):炎症局部组织内的实质细胞及间质细胞再生。限制炎症，修复组织。过度增生破坏组织，影响功能。,炎症局部有哪些基本病理变化？,?,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,(二)渗出,1.血流和血管口径的变化（炎性充血）2.液体渗出（炎性水肿）3.白细胞渗出（炎性浸润）,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,1、炎性充血,过程：1.细动脉短暂痉挛2.动脉性充血3.静脉性充血,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,2、液体渗出-炎性水肿,液体渗出：血管内含大量蛋白质的液体成分通过血管壁渗出到血管外的过程。渗出液：炎症时从血管内渗出的液体炎性水肿：渗出液进入组织间隙炎性积液：渗出液在浆膜腔和关节腔内集聚,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,1）血管壁通透性升高内皮细胞收缩，细胞间隙增宽内皮细胞损伤，脱落内皮细胞吞饮能力增强新生毛细血管壁的高通透性,（1）液体渗出的机制,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,2）微血管内流体静压升高3）组织渗透压升高,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,（2）渗出液与漏出液的区别表4-1,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,（3）渗出液的作用,有利：1.稀释毒素及有害物质；2.带来营养物质及抗体、补体，带走代谢产物；3.纤维蛋白网有利于吞噬和修复；4.刺激机体发生体液和细胞免疫反应。不利：压迫和粘连,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,白细胞穿过血管壁进入组织间隙并发挥吞噬作用，是炎症防御反应的中心环节。游出的白细胞称为炎细胞(inflammatorycells)炎细胞聚集在炎症区域的现象称为炎性浸润。,3.白细胞渗出-炎性浸润,炎症反应最核心的改变,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,白细胞渗出是一种主动过程大致步骤如下：（1）靠边和附壁（2）游出和趋化,以阿米巴样运动的形式进行。,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,红细胞无游走能力，它的逸出是被动性的渗出液中出现大量红细胞，则标志着炎症反应剧烈或血管壁损伤严重。,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,炎症的不同阶段，游出的白细胞不同致炎因子不同，渗出的白细胞也不同,P63、65,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,关于趋化（自学）,趋化性/趋化作用？趋化因子？趋化因子的作用具有特异性？,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,炎症灶内白细胞吞噬病原微生物、异物和组织碎片的过程。吞噬细胞：1.中性粒细胞(小吞噬细胞)2.巨噬细胞(大吞噬细胞)：可融合成多核巨细胞,（3）吞噬作用(phagocytosis),DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,1.识别和粘着2.包围和吞入3.杀伤和降解,吞噬过程,调理素：特异性抗体和补体，能增强吞噬细胞的识别和捕捉作用。,吞噬溶酶体,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,再次感染,有些细菌（如TB）在未激活的白细胞内不易被杀灭，平时处于静止状态，一旦机体抵抗力下降，又能繁殖，并可随吞噬细胞游走而在体内播散。,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,炎症早期血流动力学改变的顺序为()A血流减慢血管扩张，血流加速细动脉短暂收缩白细胞附壁B血管扩张，血流加速细动脉短暂收缩白细胞附壁血流减慢C细动脉短暂收缩血流减慢血管扩张，血流加速白细胞附壁D细动脉短暂收缩血管扩张，血流加速白细胞附壁血流减慢E细动脉短暂收缩血管扩张，血流加速血流减慢白细胞附壁,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,急性炎症过程中，最先发生哪种变化()A白细胞游出B白细胞附壁C吞噬作用D血流淤滞E趋化作用,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,炎症灶中吸引炎细胞定向集中的现象称为()A白细胞游出B白细胞吞噬C白细胞阿米巴运动D趋化性E白细胞渗出,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,急性炎症48小时后病灶中主要的炎性细胞是（）A淋巴细胞B嗜碱性粒细胞C中性粒细胞D巨噬细胞E肥大细胞,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,较多嗜酸性粒细胞浸润见于()A伤寒杆菌感染B变态反应或寄生虫感染C乙脑病毒感染D溶血性链球菌感染E葡萄球菌感染,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,下列哪种细胞不是通过变形运动离开血管的（）A中性粒细胞B红细胞C嗜酸性粒细胞D淋巴细胞E巨噬细胞,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,三、炎症的病理类型,按炎症局部组织的基本病变分,炎症可以分为哪几种？各种炎症的特点是什么？,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,（一）变质性炎,急性肝炎-肝细胞水肿乙脑-脑液化性坏死,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,（二）渗出性炎症,增生性炎,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,渗出性炎目录,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,HE:红染交织的网状、条状或颗粒状，常混有中性粒细胞和坏死组织碎片。,（二）纤维蛋白性炎,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,（1）发生于粘膜,气管粘膜白喉大肠粘膜菌痢,假膜性炎？,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,假膜性炎（名词解释）-发生于粘膜的纤维蛋白性炎，渗出的纤维蛋白、中性粒细胞、脱落的上皮和坏死组织等混合在一起，可形成一层膜状物，覆盖在粘膜表面，称假膜，因此，粘膜的纤维蛋白性炎又称为假膜性炎。,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,绒毛心-发生于心外膜的纤维蛋白性炎，由于心脏的不断搏动，使渗出在心包脏、壁两层表面的纤维蛋白形成无数绒毛状物。,（2）发生于浆膜,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,镜下：纤维蛋白为红染、网片状或细丝状物，夹杂有一定的中性粒细胞。,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,大叶性肺炎：以纤维蛋白为主的渗出物充满了肺泡腔肺质地变实（肝样变）,（3）发生于肺,渗出性炎目录,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,（三）化脓性炎(purulentinflammation),定义：大量中性粒细胞渗出，伴不同程度的组织坏死和脓液形成。病因：葡萄球菌（疖、痈）链球菌（化脓性阑尾炎）脑膜炎双球菌（化脓性脑膜炎）大肠杆菌（肾盂肾炎）,化脓？脓液？脓细胞?,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,类型,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,脓肿(abscess),定义组织内局限性化脓性炎症。主要特征组织发生溶解坏死，形成充满脓液的腔。好发部位皮肤、内脏器官病因、发病机制金葡菌毒素+N（蛋白溶解酶）组织坏死液化（形成脓肿）血浆凝固酶使纤维蛋白原纤维蛋白（局限病灶）,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,疖疖是毛囊、皮脂腺及其附近组织所发生的脓肿。,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,痈痈是多个疖的融合，在皮下脂肪筋膜组织形成多个互相沟通的脓肿。,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,蜂窝织炎(phlegmonousinflammation),定义疏松结缔组织的弥漫性化脓性炎好发部位皮下、肌肉间、阑尾病变特点大量中性粒细胞弥漫浸润，无脓腔形成，与正常组织分界不清，炎症灶中原有组织坏死可不明显。病因、发病机制溶血性链球菌透明质酸酶溶解透明质酸，细菌易扩散；链激酶溶解纤维蛋白（炎症弥漫）,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,化脓性尿道炎（淋病）,（3）表面化脓和积脓,渗出性炎目录,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,（四）出血性炎,血管损伤严重，渗出物中含大量红细胞常与其他炎症同时存在举例大叶性肺炎红色肝样变期（纤维蛋白性出血性炎）,渗出性炎目录,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,患者，女性，30岁，左手不慎被沸水烫伤，局部立即出现红、肿、热、痛，随之皮肤上起水泡，其病变属（）A变质性炎B浆液性炎C纤维素性炎D化脓性炎E出血性炎,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,溶血性链球菌感染最常引起()A蜂窝织炎B脓肿C纤维素性炎D假膜性炎E出血性炎,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,患者，男，45岁。因高热、咳嗽、咳大量脓痰入院。X线示一有液平面的空腔。手术切除病变肺组织，巨检见病变中央呈囊腔状，腔内含黄色脓液，镜下腔壁可见大量变性坏死中性粒细胞，可诊断为()A肺结核B肺脓肿C小叶性肺炎D大叶性肺炎E肺癌,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,急性细菌性痢疾的典型肠道病变是（）A假膜性炎B蜂窝织炎C出血性炎D化脓性炎E卡化性炎,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,五、炎症的临床分型和结局（一）临床分型,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,（三）增生性炎,以组织细胞的增生为主的炎症多为慢性炎症（2个例外？）分类：非特异性增生性炎特异性增生性炎-肉芽肿性炎,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,1、非特异性增生性炎,特点：慢性炎细胞浸润：巨噬细胞、淋巴细胞、浆细胞血管内皮细胞、成纤维细胞、上皮细胞等增生。特殊形态：炎性息肉炎性假瘤,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,炎性息肉Inflammatorypolyp,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,2、肉芽肿性炎,概念：炎症局部以巨噬细胞及其演变的细胞增生为主，形成境界清楚的结节状病灶。病理学上常能根据肉芽肿的物殊形态来帮助确定炎症的原因。,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,肺粟粒性结核-结核性肉芽肿,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,五、炎症的局部表现和全身反应,一.局部表现：红、肿、热、痛，功能障碍,甲沟炎,急性扁桃体炎,炎症有何临床表现？为什么会有这些临床表现？,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,二.全身表现：发热白细胞变化单核巨噬细胞系统增生实质器官病变,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,五、炎症的临床分型和结局（一）临床分型,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,（二）炎症的结局,痊愈迁延不愈转为慢性蔓延扩散,局部蔓延淋巴道扩散血道扩散,炎症的结局如何？,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,血道扩散,(1)菌血症(bacteremia)血液中有细菌，但无明显症状。(2)毒血症(toxemia)毒素及代谢产物吸收入血，产生全身中毒症状，血培养阴性。(3)败血症(septicemia)血中大量繁殖，产生毒素，引起寒战、高热皮肤粘膜出血点等中毒症状。(4)脓毒败血症(pyemia)败血症+多发性栓塞性脓肿。小脓肿中央的血管中可见细菌菌落。,DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying,患者女性，39岁，因经量增多，淋漓不尽行诊刮术。送检内膜组织镜下见子宫内膜间质中大量浆细胞浸润，应诊断为()A急性子宫内膜炎B慢性子宫内膜炎C子宫内膜结核D子宫内膜单纯性增生E以上均不是,DepartmentofPathology，Sha