病理学导论医学知识讲座优质课件

1、病理学导论医学知识讲座病理学导论医学知识讲座病 理 学 导 论病理学的定义 病理学发展简史病理学的分支学科病理学的研究方法病 理 学 导 论病理学的定义 Definition of PathologyThe word “Pathology” is derived from two Greek word -pathos meaning sufferinglogos meaning studyDefinition of PathologyThe worDefinition of PathologyPathology is scientific study of structure and func

2、tion of the body in disease.It deals with causes, effects, mechanisms and nature of disease. Definition of PathologyPatholoThe knowledge and understanding of pathology is essential for all would-be doctors as well as general practitioners and specialists since unless they know the causes and mechani

3、sms of disease and understand the language spoken by the pathologist in the form of laboratory reports, they would not be able to institute appropriate treatment or suggest preventive measures to the patient. The knowledge and understandinFor the medical student, the discipline of pathology forms a

4、vital bridge between initial learning phase of preclinical science and the final phase of clinical subjects.For the medical student, the d病理学发展简史从宗教迷信走向理性探索(Antiquity to AD 1500)大体病理学时期 (AD 1500 to 1800)细胞病理学时期 (AD 1800 to 1950s)现代病理学时期 (1950s to dawn of 21st century)病理学发展简史从宗教迷信走向理性探索(Antiquity t从宗

5、教迷信走向理性探索 (Antiquity to AD 1500)Hippocrates (Greece) 460-377 BCPermanently dissociated medicine from religious mysticism. Started study of patients symptoms as method of diagnosis.Stressed moralistic attitude for practice of medicine (Hippocratic oath)Cornelius Celsus (Rome) 53 BC-7 ADDescribed 4 ca

6、rdinal signs of inflammation (redness, heat, swelling, pain)从宗教迷信走向理性探索 (Antiquity to AD Hippocrates (Greece) 460-377 BCHippocrates (Greece) 460-377 大体病理学时期 (AD 1500 to 1800)Giovanni B Morgagni (Italy) 1682-1771Introduced clinicopathologic correlation (CPC) in the study of disease (cause, lesions, s

7、ymptoms, outcome) John Hunter (Scotland) 1728-1793Introduced pathology museum in the study of disease.R.T.H. Laennec (France) 1781-1826Described several lung diseases such as various tuberculous lesions of lungs, bronchiectasis. Described cirrhosis of liver (later called Laennecs cirrhosis).Invented

8、 stethoscope. 大体病理学时期 (AD 1500 to 1800)GiovaJohn Hunter (Scotland) 1728-1793John Hunter (Scotland) 1728-1R.T.H. Laennec (France) 1781-1826R.T.H. Laennec (France) 1781-1细胞病理学时期 (AD 1800 to 1950s)Rudolf Virchow (Germany) 1821-1905Father of cellular pathologyIntroduced histopathology as a diagnostic br

9、anch by his cellular theoryGeorge N. Papanicolaou (USA) 1883-1962Father of exfoliative cytology Developed Pap smear for detection of cervical cancer in 1930s 细胞病理学时期 (AD 1800 to 1950s)RudoRudolf Virchow (Germany) 1821-1905Rudolf Virchow (Germany) 1821George N. Papanicolaou (USA) 1883-1962George N. P

10、apanicolaou (USA) 1现代病理学时期 (1950s to dawn of 21st century)Watson and Crick 1953Described the structure of DNANowell and Hagerford 1960Philadelphia chromosome in CML i.e. t(9;22)Gall and Pardue 1969In Situ HybridizationKary Mullis 1983Introduced polymerase chain reaction (PCR)现代病理学时期 (1950s to dawn o

11、f 21s著名病理学家 梁伯强教授 1899-1968 著名病理学家 梁伯强教授 1899-1968 著名病理学家 秦光煜教授 1902-1969 著名病理学家 秦光煜教授 1902-1969 病理学的分支学科General Pathology - dealing with general principles of diseaseSystemic Pathology - includes study of diseases pertaining to the specific organs and body systems病理学的分支学科General Pathology - General

12、 Pathology （总论）细胞、组织的适应与损伤损伤的修复局部血液循环障碍炎症肿瘤免疫性疾病General Pathology （总论）细胞、组织的适应Systemic Pathology （各论）心血管系统疾病呼吸系统疾病消化系统疾病淋巴造血系统疾病泌尿系统疾病生殖系统疾病内分泌系统疾病神经系统疾病Systemic Pathology （各论）心血管系统疾病病理学的分支学科Histo-PathologyExperimental PathologyMolecular Pathology Chemical PathologyGeographic Pathology ImmunologyHae

13、matologyMedical Genetics病理学的分支学科Histo-Pathology实验病理学Experimental Pathology 19世纪法国生理学家Claude Bernard首创了实验病理学，在动物身上研究疾病的动态变化以及病因和发病机理，揭示疾病发生发展的规律。实验病理学Experimental Pathology 实验病理学研究方法 1动物实验(animal experiment) 2组织和细胞培养(tissue and cell culture) 实验病理学研究方法 1动物实验(animal expe3其它研究技术 (1)流式细胞术(flowcytometry，F

14、CM)(2)图像分析技术(Image analysis，IA)(3)激光扫描共聚焦显微术（Confocal laser scanning microscope，CLSM)(4)生物芯片技术（biochip technique） (5)激光显微切割技术(laser capture microdesection，LCM)(6)原位分子杂交技术（in situ hybridization,ISH）(7)荧光原位分子杂交染色体分析技术(FISH)(8)比较基因组杂交技术(CGH)3其它研究技术 (1)流式细胞术(flowcytomet分子病理学Molecular Pathology 分子病理学是现代分

15、子生物学与传统病理学相互融合而形成的一门新兴学科，旨在探讨疾病发生过程中可能出现的分子事件，以及这些事件与疾病发生的关系，并最终揭示疾病发生的根本机制。分子病理学Molecular Pathology 病理学导论医学知识讲座优质课件Signal-transducing proteinsThe BCR-ABL hybrid protein has potent, unregulated tyrosine kinase activity, which activates several pathways, including the Ras-Raf cascade.A cell with BCR-

16、ABL fusion gene is dysregulated in two ways: inappropriate tyrosine kinase activity leads to growth autonomy, while simultaneously apoptosis is impaired.Signal-transducing proteinsTheSignal-transducing proteinsThe crucial role of BCR-ABL in transformation has been confirmed by the dramatic clinical

17、response of patients with chronic myeloid leukemia after therapy with an inhibitor of the BCR-ABL fusion kinase called imatinib mesylate (Gleevec) .Signal-transducing proteinsThe病理学的研究方法尸体剖验 Autopsy活体组织检查 Biopsy细胞学检查 Cytology病理学的研究方法尸体剖验 Autopsy尸体剖验 Autopsy 简称尸检，即对死者的遗体进行病理解剖，是病理学的基本研究方法之一。尸体剖验 Auto

18、psy 简称尸检，即对死者的遗体尸体剖验的意义确定病变，查明死因发现和确诊传染病、地方病、流行病和新发生的疾病积累各种疾病的人体病理材料 尸体剖验的意义确定病变，查明死因Coronary thrombosis, gross Coronary thrombosis, gross Coronary thrombosis, gross Coronary thrombosis, gross . Acute myocardial infarction, gross. Acute myocardial infarction,. Acute myocardial infarction, gross . Ac

19、ute myocardial infarctionPulmonary thromboembolus, gross Pulmonary thromboembolus, grosPulmonary thromboembolus, gross Pulmonary thromboembolus, grosPulmonary thromboembolus, gross Pulmonary thromboembolus, gros病理学导论医学知识讲座优质课件代偿性肥大Hypertrophy, heart, gross 代偿性肥大Hypertrophy, heart, grosFatty metamorp

20、hosis of liver, gross Fatty metamorphosis of liver, 活体组织检查 Biopsy 简称活检，即用局部切取、钳取、细针穿刺、搔刮和摘取等手术方法从患者活体获取病变组织进行病理诊断。 活体组织检查 Biopsy 简称活检，即用局活体组织检查的意义作出准确病理诊断，指导治疗和估计预后冰冻切片可快速诊断，协助选择手术治疗方案定期活检可连续了解病变的发展，判断疗效 活体组织检查的意义作出准确病理诊断，指导治疗和估计预后为临床选择治疗方案提供依据明确病因（肿瘤或炎症）治疗方案 良性肿瘤或恶性肿瘤确定手术范围 良性病变有否恶变确定手术范围 原位癌或浸润癌确定

21、手术范围 肺小细胞癌或非小细胞癌治疗方案 淋巴瘤或其它肿瘤化疗或手术为临床选择治疗方案提供依据提供疾疾病严重程度及预后的信息 恶性肿瘤的组织学类型不同，预后不同 肿瘤有无转移，预后不同 有无激素受体，对治疗的敏感性和效果不同提供疾疾病严重程度及预后的信息 帮助临床判断疗效 肝穿刺判断肝炎的治疗效果 移植后穿刺判断移植物情况、有无排斥 骨髓穿刺白血病治疗疗效， 骨髓移植后情况帮助临床判断疗效活体组织检查的步骤取材、固定脱水、浸蜡包埋、切片染色、封片阅片诊断病理报告 活体组织检查的步骤取材、固定取材取材固定、脱水、浸蜡固定、脱水、浸蜡包埋包埋切片切片贴片贴片HE染色HE染色封片封片阅片诊断阅片诊断细胞学检查 Cytology 通过采集病变处的细胞涂片染色后进行诊断。细胞学检查除用于病人外，还用于肿瘤的普查。此法设备简单，操作简便，病人痛苦少而易于接受。 细胞学检查 Cytology 通过采集病变 细胞的来源： 女性生殖道、口腔、食管、鼻咽部等 自然分泌物（如痰、乳腺溢液、前列腺液等） 体液（如胸腹腔积液、心包积液和脑脊液等） 排泄物（如尿液中的细胞） 内窥镜采集或刷取的细胞（如食管拉网、纤支镜刷片） 细针直接穿刺病变部位(如前列腺、肝、肾、胰腺、乳腺、甲状腺、淋巴结等）所吸取的细胞。 细胞的来源： 女性生殖道、口腔、食管、鼻咽