組織病理學基礎

炎癥

整理課件

組織病理學基礎

炎癥

整理課件DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying知識框架概述炎癥局部的基本病理變化炎癥的類型及病理變化特點炎癥的局部表現和全身反應炎癥的臨床分型和結局知識目標整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying一、概述具有血管系統的活體組織對致炎因子所致局部損害而發生的以防御為主的反應。致炎因子？最常見的致炎因子？感染？什么是炎癥？整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying致炎因子引起損傷性變化→血管反應（血管擴張→血漿及白細胞滲出→局限和消滅損傷因子，清除和吸收壞死組織和細胞）→實質細胞和間質細胞再生修復損傷血管反應是炎癥過程的中心環節變質增生炎癥過程炎癥反應是如何發生的？整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying早期變質滲出增生損傷性反應防御性反應晚期整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying炎癥介質(inflammatorymediator)定義：

一組參與并誘導炎癥發生發展的具有生物活性的化學物質作用：1、促進血管反應，使血管壁通透性增高2、對炎細胞的趨化作用3、引起發熱、疼痛等整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying炎癥是機體的一種（）免疫反應局部反應全身性反應防御性反應細菌或病毒反應整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying炎癥過程的中心環節是（）A．細胞和組織的各種損傷B．白細胞對損傷因子的吞噬作用C．血管反應D．修復損傷E．實質細胞和間質細胞增生整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying炎癥最常見的病因是（）A．物理性因子B．化學性因子C．壞死組織D．生物性因子E．變態反應整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying二、炎癥局部的基本病理變化

變質(alteration):

炎癥局部組織或細胞發生變性和壞死。促進滲出發生。滲出(exudation):

炎癥灶血管內的液體和細胞成分通過血管壁進入組織間隙、體腔、體表和粘膜表面的過程。增生(proliferation):

炎癥局部組織內的實質細胞及間質細胞再生。限制炎癥，修復組織。過度增生破壞組織，影響功能。炎癥局部有哪些基本病理變化？?整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying(二)滲出

1.血流和血管口徑的變化（炎性充血）2.液體滲出（炎性水腫）

3.白細胞滲出（炎性浸潤）整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying1、炎性充血過程：1.細動脈短暫痙攣2.動脈性充血3.靜脈性充血整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying2、液體滲出---炎性水腫

液體滲出：血管內含大量蛋白質的液體成分通過血管壁滲出到血管外的過程。滲出液：炎癥時從血管內滲出的液體炎性水腫：滲出液進入組織間隙炎性積液：滲出液在漿膜腔和關節腔內集聚整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying1）血管壁通透性升高內皮細胞收縮，細胞間隙增寬內皮細胞損傷，脫落內皮細胞吞飲能力增強新生毛細血管壁的高通透性（1）液體滲出的機制整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying2）微血管內流體靜壓升高3）組織滲透壓升高整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying（2）滲出液與漏出液的區別

表4-1整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying（3）滲出液的作用有利：1.稀釋毒素及有害物質；2.帶來營養物質及抗體、補體，帶走代謝產物；3.纖維蛋白網有利于吞噬和修復；4.刺激機體發生體液和細胞免疫反應。不利：壓迫和粘連整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying

白細胞穿過血管壁進入組織間隙并發揮吞噬作用，是炎癥防御反應的中心環節。游出的白細胞稱為炎細胞(inflammatorycells)炎細胞聚集在炎癥區域的現象稱為炎性浸潤。

3.白細胞滲出---炎性浸潤炎癥反應最核心的改變整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying

白細胞滲出是一種主動過程大致步驟如下：（1）靠邊和附壁（2）游出和趨化

以阿米巴樣運動的形式進行。整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying紅細胞無游走能力，它的逸出是被動性的滲出液中出現大量紅細胞，則標志著炎癥反應劇烈或血管壁損傷嚴重。整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying炎癥的不同階段，游出的白細胞不同致炎因子不同，滲出的白細胞也不同中性粒細胞急性炎癥早期和化膿性炎單核細胞急性炎癥后期、肉芽腫性炎淋巴細胞慢性炎癥、病毒感染漿細胞慢性炎癥嗜酸性粒細胞變態反應、寄生蟲感染P63、65整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying關于趨化（自學）趨化性/趨化作用？趨化因子？趨化因子的作用具有特異性？整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying炎癥灶內白細胞吞噬病原微生物、異物和組織碎片的過程。吞噬細胞：1.中性粒細胞(小吞噬細胞)2.巨噬細胞(大吞噬細胞)：可融合成多核巨細胞（3）吞噬作用(phagocytosis)整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying1.識別和粘著2.包圍和吞入3.殺傷和降解

吞噬過程調理素：特異性抗體和補體，能增強吞噬細胞的識別和捕捉作用。吞噬溶酶體整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying再次感染有些細菌（如TB）在未激活的白細胞內不易被殺滅，平時處于靜止狀態，一旦機體抵抗力下降，又能繁殖，并可隨吞噬細胞游走而在體內播散。整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying炎癥早期血流動力學改變的順序為()A．血流減慢→血管擴張，血流加速→細動脈短暫收縮→白細胞附壁B．血管擴張，血流加速→細動脈短暫收縮→白細胞附壁→血流減慢C．細動脈短暫收縮→血流減慢→血管擴張，血流加速→白細胞附壁D．細動脈短暫收縮→血管擴張，血流加速→白細胞附壁→血流減慢E．細動脈短暫收縮→血管擴張，血流加速→血流減慢→白細胞附壁整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying急性炎癥過程中，最先發生哪種變化()A．白細胞游出B．白細胞附壁C．吞噬作用D．血流淤滯E．趨化作用整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying炎癥灶中吸引炎細胞定向集中的現象稱為()A．白細胞游出B．白細胞吞噬C．白細胞阿米巴運動D．趨化性E．白細胞滲出整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying急性炎癥48小時后病灶中主要的炎性細胞是（）A．淋巴細胞B．嗜堿性粒細胞C．中性粒細胞D．巨噬細胞E．肥大細胞整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying較多嗜酸性粒細胞浸潤見于()A．傷寒桿菌感染B．變態反應或寄生蟲感染C．乙腦病毒感染D．溶血性鏈球菌感染E．葡萄球菌感染整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying下列哪種細胞不是通過變形運動離開血管的（）A．中性粒細胞B．紅細胞C．嗜酸性粒細胞D．淋巴細胞E．巨噬細胞整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying三、炎癥的病理類型變質性炎以組織細胞的變性壞死為主多見于急性炎癥：急性乙型肝炎、乙腦滲出性炎以炎癥灶內形成大量滲出物為特征多見于急性炎癥，又分漿液性炎、纖維蛋白性炎、化膿性炎、出血性炎增生性炎以組織細胞的增生為主多為慢性炎癥（急性：腎炎、傷寒）按炎癥局部組織的基本病變分炎癥可以分為哪幾種？各種炎癥的特點是什么？整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying（一）變質性炎急性肝炎---肝細胞水腫乙腦---腦液化性壞死

整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying（二）滲出性炎癥類型特點好發部位及代表性疾病漿液性炎以漿液滲出為主炎癥較輕，易于消退粘膜---感冒漿膜---胸膜炎疏松結締組織---二度燙傷纖維蛋白性炎以滲出物含大量纖維蛋白為特征粘膜---假膜性炎：痢疾，白喉漿膜---絨毛心肺---大葉性肺炎化膿性炎以中性粒細胞滲出為主，伴組織壞死、膿液形成表面化膿和積膿---尿道、膽囊膿腫---皮膚、內臟蜂窩織炎---肌肉、闌尾出血性炎血管損傷嚴重，滲出物含大量紅細胞流行性出血熱、鉤體增生性炎整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying滲出性炎目錄整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-yingHE:紅染交織的網狀、條狀或顆粒狀，常混有中性粒細胞和壞死組織碎片。（二）纖維蛋白性炎整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying（1）發生于粘膜

氣管粘膜——白喉大腸粘膜—菌痢假膜性炎？整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying假膜性炎（名詞解釋）----發生于粘膜的纖維蛋白性炎，滲出的纖維蛋白、中性粒細胞、脫落的上皮和壞死組織等混合在一起，可形成一層膜狀物，覆蓋在粘膜表面，稱假膜，因此，粘膜的纖維蛋白性炎又稱為假膜性炎。

整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying絨毛心------

發生于心外膜的纖維蛋白性炎，由于心臟的不斷搏動，使滲出在心包臟、壁兩層表面的纖維蛋白形成無數絨毛狀物。（2）發生于漿膜整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying鏡下：纖維蛋白為紅染、網片狀或細絲狀物，夾雜有一定的中性粒細胞。整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying大葉性肺炎：以纖維蛋白為主的滲出物充滿了肺泡腔——肺質地變實（肝樣變）

（3）發生于肺滲出性炎目錄整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying（三）化膿性炎(purulentinflammation)定義：大量中性粒細胞滲出，伴不同程度的組織壞死和膿液形成。病因：

葡萄球菌（癤、癰）鏈球菌（化膿性闌尾炎）腦膜炎雙球菌（化膿性腦膜炎）大腸桿菌（腎盂腎炎）化膿？膿液？膿細胞?整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying類型膿腫多發生于皮膚和內臟局限性,與周圍組織分界清楚蜂窩織炎疏松結締組織：皮下、肌肉間、闌尾彌漫性,與周圍組織分界不清表面化膿和積膿粘膜漿膜，囊、腔、管表淺，不累及深部組織整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying膿腫(abscess)定義—組織內局限性化膿性炎癥。主要特征—組織發生溶解壞死，形成充滿膿液的腔。好發部位—皮膚、內臟器官病因、發病機制—金葡菌

毒素+N（蛋白溶解酶）→組織壞死→液化（形成膿腫）血漿凝固酶使纖維蛋白原→纖維蛋白（局限病灶）

整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying[癤]癤是毛囊、皮脂腺及其附近組織所發生的膿腫。整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying[癰]癰是多個癤的融合，在皮下脂肪筋膜組織形成多個互相溝通的膿腫。整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying蜂窩織炎(phlegmonousinflammation)定義——疏松結締組織的彌漫性化膿性炎好發部位——皮下、肌肉間、闌尾病變特點——大量中性粒細胞彌漫浸潤，無膿腔形成，與正常組織分界不清，炎癥灶中原有組織壞死可不明顯。病因、發病機制——溶血性鏈球菌

透明質酸酶→溶解透明質酸，細菌易擴散；鏈激酶→溶解纖維蛋白（炎癥彌漫）整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying化膿性尿道炎（淋病）（3）表面化膿和積膿滲出性炎目錄整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying（四）出血性炎血管損傷嚴重，滲出物中含大量紅細胞常與其他炎癥同時存在舉例——大葉性肺炎紅色肝樣變期（纖維蛋白性出血性炎）滲出性炎目錄整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying患者，女性，30歲，左手不慎被沸水燙傷，局部立即出現紅、腫、熱、痛，隨之皮膚上起水泡，其病變屬（）A．變質性炎B．漿液性炎C．纖維素性炎D．化膿性炎E．出血性炎整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying溶血性鏈球菌感染最常引起()A．蜂窩織炎B．膿腫C．纖維素性炎D．假膜性炎E．出血性炎整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying患者，男，45歲。因高熱、咳嗽、咳大量膿痰入院。X線示一有液平面的空腔。手術切除病變肺組織，巨檢見病變中央呈囊腔狀，腔內含黃色膿液，鏡下腔壁可見大量變性壞死中性粒細胞，可診斷為()A．肺結核B．肺膿腫C．小葉性肺炎D．大葉性肺炎E．肺癌整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying急性細菌性痢疾的典型腸道病變是（）A．假膜性炎B．蜂窩織炎C．出血性炎D．化膿性炎E．卡化性炎整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying五、炎癥的臨床分型和結局

（一）臨床分型病程臨床表現病理變化超急性炎癥幾小時-幾天暴發性經過，反應劇烈組織器官嚴重損害，多屬變態反應性炎急性炎癥幾天-1個月起病急，癥狀明顯以變質滲出為主，中性粒細胞浸潤亞急性炎癥1個月-幾個月少見，常由急性轉變而來/慢性炎癥幾個月-幾年起病緩慢，臨床表現不明顯以增生為主，慢性炎細胞浸潤整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying（三）增生性炎以組織細胞的增生為主的炎癥多為慢性炎癥（2個例外？）分類：非特異性增生性炎特異性增生性炎---肉芽腫性炎整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying1、非特異性增生性炎特點：慢性炎細胞浸潤：巨噬細胞、淋巴細胞、漿細胞血管內皮細胞、成纖維細胞、上皮細胞等增生。特殊形態：炎性息肉炎性假瘤整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying炎性息肉Inflammatorypolyp整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying2、肉芽腫性炎概念：炎癥局部以巨噬細胞及其演變的細胞增生為主，形成境界清楚的結節狀病灶。病理學上常能根據肉芽腫的物殊形態來幫助確定炎癥的原因。類型病因/特殊形態感染性肉芽腫結核---結核結節：上皮樣細胞、朗漢斯巨細胞傷寒---傷寒小結：傷寒細胞風濕---風濕小體：風濕細胞異物肉芽腫硅塵、外科縫線---異物巨細胞整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying肺粟粒性結核---結核性肉芽腫整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying五、炎癥的局部表現和全身反應一.局部表現：紅、腫、熱、痛，功能障礙甲溝炎急性扁桃體炎炎癥有何臨床表現？為什么會有這些臨床表現？整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying二.全身表現：發熱白細胞變化單核巨噬細胞系統增生實質器官病變整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying五、炎癥的臨床分型和結局

（一）臨床分型病程臨床表現病理變化超急性炎癥幾小時-幾天暴發性經過，反應劇烈組織器官嚴重損害，多屬變態反應性炎急性炎癥幾天-1個月起病急，癥狀明顯以變質滲出為主，中性粒細胞浸潤亞急性炎癥1個月-幾個月少見，常由急性轉變而來/慢性炎癥幾個月-幾年起病緩慢，臨床表現不明顯以增生為主，慢性炎細胞浸潤整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying（二）炎癥的結局痊愈遷延不愈轉為慢性蔓延擴散局部蔓延淋巴道擴散血道擴散炎癥的結局如何？整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying血道擴散(1)菌血癥(bacteremia)

血液中有細菌，但無明顯癥狀。(2)毒血癥(toxemia)

毒素及代謝產物吸收入血，產生全身中毒癥狀，血培養陰性。(3)敗血癥(septicemia)

血中大量繁殖，產生毒素，引起寒戰、高熱皮膚粘膜出血點等中毒癥狀。(4)膿毒敗血癥(pyemia)

敗血癥+多發性栓塞性膿腫。小膿腫中央的血管中可見細菌菌落。整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying患者女性，39歲，因經量增多，淋漓不盡行診刮術。送檢內膜組織鏡下見子宮內膜間質中大量漿細胞浸潤，應診斷為()A．急性子宮內膜炎B．慢性子宮內膜炎C．子宮內膜結核D．子宮內膜單純性增生E．以上均不是整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying大量細菌毒素入血，導致實質細胞變性、壞死及全身中毒癥狀的稱()A．菌血癥B．毒血癥C．敗血癥D．白血病E．膿毒血癥整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying下列哪項不是敗血癥的表現()A．細菌入血并產生毒素B．高熱寒戰C．一些內臟器官的多發性小膿腫D．皮膚．黏膜點狀出血E．脾腫大整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying學習目標掌握：炎癥、炎癥介質及肉芽腫性炎的概念；炎癥的基本病理變化；滲出液的作用、白細胞的作用；常見的炎癥類型及形態特點。熟悉：炎癥滲出的過程、滲出液與漏出液的區別、白細胞的滲出過程；炎癥的局部表現和全身反應；炎癥的臨床分型及結局。了解：炎癥的原因，炎癥介質的常見類型及其作用。整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying思考題一、名詞解釋：炎癥、炎癥介質、滲出、趨化作用、假膜性炎、絨毛心、肉芽腫性炎二、問答題：炎癥的基本病理變化有哪些？他們之間關系如何？哪一種變化最核心？何謂化膿性炎？常見哪幾種類型？各類有何特點？整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying第三節腫瘤預習參考題什么是腫瘤？哪些稱癌？哪些稱肉瘤？腫瘤有哪些特性？如何診斷腫瘤？什么是腫瘤的轉移？腫瘤對機體有何影響？如何區分良性腫瘤和惡性腫瘤？如何早期發現及早期診斷癌？整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-yingTHANKYOU整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying膿腫與蜂窩織炎的區別膿腫蜂窩織炎定義局限性化膿性炎彌漫性化膿性炎常見致病菌金黃色葡萄球菌溶血性鏈球菌致病機理分泌血漿凝固酶分泌透明質酸酶好發部位皮下、內臟皮膚、肌肉、闌尾病變特點膿腔形成組織內水腫、中性粒細胞浸潤炎癥分界清不清中毒癥狀較輕較重修復瘢痕修復不留瘢痕整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying細菌入血繁殖產生毒素血中查細菌中毒癥狀器官病變菌血癥+-+--毒血癥-毒素入血-++敗血癥+++++膿毒敗血癥+++++，多器官膿腫

整理課件DepartmentofPathology，Shaox

組織病理學基礎

炎癥

整理課件

組織病理學基礎

炎癥

整理課件DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying知識框架概述炎癥局部的基本病理變化炎癥的類型及病理變化特點炎癥的局部表現和全身反應炎癥的臨床分型和結局知識目標整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying一、概述具有血管系統的活體組織對致炎因子所致局部損害而發生的以防御為主的反應。致炎因子？最常見的致炎因子？感染？什么是炎癥？整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying致炎因子引起損傷性變化→血管反應（血管擴張→血漿及白細胞滲出→局限和消滅損傷因子，清除和吸收壞死組織和細胞）→實質細胞和間質細胞再生修復損傷血管反應是炎癥過程的中心環節變質增生炎癥過程炎癥反應是如何發生的？整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying早期變質滲出增生損傷性反應防御性反應晚期整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying炎癥介質(inflammatorymediator)定義：

一組參與并誘導炎癥發生發展的具有生物活性的化學物質作用：1、促進血管反應，使血管壁通透性增高2、對炎細胞的趨化作用3、引起發熱、疼痛等整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying炎癥是機體的一種（）免疫反應局部反應全身性反應防御性反應細菌或病毒反應整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying炎癥過程的中心環節是（）A．細胞和組織的各種損傷B．白細胞對損傷因子的吞噬作用C．血管反應D．修復損傷E．實質細胞和間質細胞增生整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying炎癥最常見的病因是（）A．物理性因子B．化學性因子C．壞死組織D．生物性因子E．變態反應整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying二、炎癥局部的基本病理變化

變質(alteration):

炎癥局部組織或細胞發生變性和壞死。促進滲出發生。滲出(exudation):

炎癥灶血管內的液體和細胞成分通過血管壁進入組織間隙、體腔、體表和粘膜表面的過程。增生(proliferation):

炎癥局部組織內的實質細胞及間質細胞再生。限制炎癥，修復組織。過度增生破壞組織，影響功能。炎癥局部有哪些基本病理變化？?整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying(二)滲出

1.血流和血管口徑的變化（炎性充血）2.液體滲出（炎性水腫）

3.白細胞滲出（炎性浸潤）整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying1、炎性充血過程：1.細動脈短暫痙攣2.動脈性充血3.靜脈性充血整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying2、液體滲出---炎性水腫

液體滲出：血管內含大量蛋白質的液體成分通過血管壁滲出到血管外的過程。滲出液：炎癥時從血管內滲出的液體炎性水腫：滲出液進入組織間隙炎性積液：滲出液在漿膜腔和關節腔內集聚整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying1）血管壁通透性升高內皮細胞收縮，細胞間隙增寬內皮細胞損傷，脫落內皮細胞吞飲能力增強新生毛細血管壁的高通透性（1）液體滲出的機制整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying2）微血管內流體靜壓升高3）組織滲透壓升高整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying（2）滲出液與漏出液的區別

表4-1整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying（3）滲出液的作用有利：1.稀釋毒素及有害物質；2.帶來營養物質及抗體、補體，帶走代謝產物；3.纖維蛋白網有利于吞噬和修復；4.刺激機體發生體液和細胞免疫反應。不利：壓迫和粘連整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying

白細胞穿過血管壁進入組織間隙并發揮吞噬作用，是炎癥防御反應的中心環節。游出的白細胞稱為炎細胞(inflammatorycells)炎細胞聚集在炎癥區域的現象稱為炎性浸潤。

3.白細胞滲出---炎性浸潤炎癥反應最核心的改變整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying

白細胞滲出是一種主動過程大致步驟如下：（1）靠邊和附壁（2）游出和趨化

以阿米巴樣運動的形式進行。整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying紅細胞無游走能力，它的逸出是被動性的滲出液中出現大量紅細胞，則標志著炎癥反應劇烈或血管壁損傷嚴重。整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying炎癥的不同階段，游出的白細胞不同致炎因子不同，滲出的白細胞也不同中性粒細胞急性炎癥早期和化膿性炎單核細胞急性炎癥后期、肉芽腫性炎淋巴細胞慢性炎癥、病毒感染漿細胞慢性炎癥嗜酸性粒細胞變態反應、寄生蟲感染P63、65整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying關于趨化（自學）趨化性/趨化作用？趨化因子？趨化因子的作用具有特異性？整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying炎癥灶內白細胞吞噬病原微生物、異物和組織碎片的過程。吞噬細胞：1.中性粒細胞(小吞噬細胞)2.巨噬細胞(大吞噬細胞)：可融合成多核巨細胞（3）吞噬作用(phagocytosis)整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying1.識別和粘著2.包圍和吞入3.殺傷和降解

吞噬過程調理素：特異性抗體和補體，能增強吞噬細胞的識別和捕捉作用。吞噬溶酶體整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying再次感染有些細菌（如TB）在未激活的白細胞內不易被殺滅，平時處于靜止狀態，一旦機體抵抗力下降，又能繁殖，并可隨吞噬細胞游走而在體內播散。整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying炎癥早期血流動力學改變的順序為()A．血流減慢→血管擴張，血流加速→細動脈短暫收縮→白細胞附壁B．血管擴張，血流加速→細動脈短暫收縮→白細胞附壁→血流減慢C．細動脈短暫收縮→血流減慢→血管擴張，血流加速→白細胞附壁D．細動脈短暫收縮→血管擴張，血流加速→白細胞附壁→血流減慢E．細動脈短暫收縮→血管擴張，血流加速→血流減慢→白細胞附壁整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying急性炎癥過程中，最先發生哪種變化()A．白細胞游出B．白細胞附壁C．吞噬作用D．血流淤滯E．趨化作用整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying炎癥灶中吸引炎細胞定向集中的現象稱為()A．白細胞游出B．白細胞吞噬C．白細胞阿米巴運動D．趨化性E．白細胞滲出整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying急性炎癥48小時后病灶中主要的炎性細胞是（）A．淋巴細胞B．嗜堿性粒細胞C．中性粒細胞D．巨噬細胞E．肥大細胞整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying較多嗜酸性粒細胞浸潤見于()A．傷寒桿菌感染B．變態反應或寄生蟲感染C．乙腦病毒感染D．溶血性鏈球菌感染E．葡萄球菌感染整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying下列哪種細胞不是通過變形運動離開血管的（）A．中性粒細胞B．紅細胞C．嗜酸性粒細胞D．淋巴細胞E．巨噬細胞整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying三、炎癥的病理類型變質性炎以組織細胞的變性壞死為主多見于急性炎癥：急性乙型肝炎、乙腦滲出性炎以炎癥灶內形成大量滲出物為特征多見于急性炎癥，又分漿液性炎、纖維蛋白性炎、化膿性炎、出血性炎增生性炎以組織細胞的增生為主多為慢性炎癥（急性：腎炎、傷寒）按炎癥局部組織的基本病變分炎癥可以分為哪幾種？各種炎癥的特點是什么？整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying（一）變質性炎急性肝炎---肝細胞水腫乙腦---腦液化性壞死

整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying（二）滲出性炎癥類型特點好發部位及代表性疾病漿液性炎以漿液滲出為主炎癥較輕，易于消退粘膜---感冒漿膜---胸膜炎疏松結締組織---二度燙傷纖維蛋白性炎以滲出物含大量纖維蛋白為特征粘膜---假膜性炎：痢疾，白喉漿膜---絨毛心肺---大葉性肺炎化膿性炎以中性粒細胞滲出為主，伴組織壞死、膿液形成表面化膿和積膿---尿道、膽囊膿腫---皮膚、內臟蜂窩織炎---肌肉、闌尾出血性炎血管損傷嚴重，滲出物含大量紅細胞流行性出血熱、鉤體增生性炎整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying滲出性炎目錄整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-yingHE:紅染交織的網狀、條狀或顆粒狀，常混有中性粒細胞和壞死組織碎片。（二）纖維蛋白性炎整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying（1）發生于粘膜

氣管粘膜——白喉大腸粘膜—菌痢假膜性炎？整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying假膜性炎（名詞解釋）----發生于粘膜的纖維蛋白性炎，滲出的纖維蛋白、中性粒細胞、脫落的上皮和壞死組織等混合在一起，可形成一層膜狀物，覆蓋在粘膜表面，稱假膜，因此，粘膜的纖維蛋白性炎又稱為假膜性炎。

整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying絨毛心------

發生于心外膜的纖維蛋白性炎，由于心臟的不斷搏動，使滲出在心包臟、壁兩層表面的纖維蛋白形成無數絨毛狀物。（2）發生于漿膜整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying鏡下：纖維蛋白為紅染、網片狀或細絲狀物，夾雜有一定的中性粒細胞。整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying大葉性肺炎：以纖維蛋白為主的滲出物充滿了肺泡腔——肺質地變實（肝樣變）

（3）發生于肺滲出性炎目錄整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying（三）化膿性炎(purulentinflammation)定義：大量中性粒細胞滲出，伴不同程度的組織壞死和膿液形成。病因：

葡萄球菌（癤、癰）鏈球菌（化膿性闌尾炎）腦膜炎雙球菌（化膿性腦膜炎）大腸桿菌（腎盂腎炎）化膿？膿液？膿細胞?整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying類型膿腫多發生于皮膚和內臟局限性,與周圍組織分界清楚蜂窩織炎疏松結締組織：皮下、肌肉間、闌尾彌漫性,與周圍組織分界不清表面化膿和積膿粘膜漿膜，囊、腔、管表淺，不累及深部組織整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying膿腫(abscess)定義—組織內局限性化膿性炎癥。主要特征—組織發生溶解壞死，形成充滿膿液的腔。好發部位—皮膚、內臟器官病因、發病機制—金葡菌

毒素+N（蛋白溶解酶）→組織壞死→液化（形成膿腫）血漿凝固酶使纖維蛋白原→纖維蛋白（局限病灶）

整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying[癤]癤是毛囊、皮脂腺及其附近組織所發生的膿腫。整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying[癰]癰是多個癤的融合，在皮下脂肪筋膜組織形成多個互相溝通的膿腫。整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying蜂窩織炎(phlegmonousinflammation)定義——疏松結締組織的彌漫性化膿性炎好發部位——皮下、肌肉間、闌尾病變特點——大量中性粒細胞彌漫浸潤，無膿腔形成，與正常組織分界不清，炎癥灶中原有組織壞死可不明顯。病因、發病機制——溶血性鏈球菌

透明質酸酶→溶解透明質酸，細菌易擴散；鏈激酶→溶解纖維蛋白（炎癥彌漫）整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying化膿性尿道炎（淋病）（3）表面化膿和積膿滲出性炎目錄整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying（四）出血性炎血管損傷嚴重，滲出物中含大量紅細胞常與其他炎癥同時存在舉例——大葉性肺炎紅色肝樣變期（纖維蛋白性出血性炎）滲出性炎目錄整理課件DepartmentofPathology，Shao