第2章-损伤B1.ppt

1.What is Pathology?,病理学是研究疾病的病因(,etiology)、,发病机理(,pathogenesis)、,病理改变(,morphology),和转归(,consequences),的一门医学基础主干学科。,Pathology may be defined as scientific study of the causes,pathogenesis,pathologic changes and consequences of diseases.,Etiology-,cause of disease,Pathogenesis-,mechanisms of disease,Morphology-,Structural Changes,Consequences,Outcomes&Complications,Diagnosis-,Pathological,Diagnosis,Treatment,Prevention,Pathology lies at center of medicine.,病理学在医学中的地位,Bridging Subject,大体观察-器官病理学,(,Organ Pathology),Specimens of cerebrum,尸体解剖,autopsy,大体检查,Gross exam,大体标本,specimens,组织学观察-组织病理学,(,Histopathology),手术、内镜、穿刺,石蜡切片(,slide，5m),HE,染色(常规染色),(,Hematoxylin-Eosin Stain,),显微镜,(,light microscope),活体组织检查(,biopsy)(,活检,),细胞学观察-细胞病理学,(,Cytopathology),痰,尿,分泌物,渗出物,细针吸取物,涂片(,smear),染色,细胞学检查（,cytology）,针吸细胞学,(Fine needle aspiration cytology,FNAC),组织化学观察-组织化学,(,Histochemistry),化学反应显示组织细胞特殊化学成分,显色反应,银染色-网状纤维,PAS,染色-糖元,特殊染色(,Special staining),免疫组织化学观察-免疫病理学,(,Immunopathology),免疫组化,(Immunohistochemistry),电镜观察-超微病理学,(,Ultrastructural Pathology),电子显微镜,EM,(,electron microscope),超薄切片,50-80,nm,(,ultrathin,section),超微结构(,ultrastructure,),放大100万倍,(光镜,100-1500,倍,),病毒颗粒,PCR,(,聚合酶链式反应，,polymerase chain reaction),FISH(,荧光原位杂交,（,Fluorescence in situ hybridization,）,ISH(,原位核酸分子杂交，,in situ hybridization),DNA,测序,基因芯片(,gene chip),分子病理学检查,分子病理学技术-分子病理学,（,Molecular Pathology）,图象分析(,Image analysis),定量测试和分析,定量诊断分类和预后判断,定量病理学(,Quantitative Pathology）,网络技术-远程病理学,(,Telepathology,),图象分析技术-定量病理学,(,Quantitative Pathology）,病理学发展,(,Evolution of Pathology),器官病理学,组织病理学,超微病理学,免疫病理学,分子病理学,信息病理学,Virchow(1821-1902),？,病理学的基本内容（,content,）,病理学总论,(General Pathology),第,15,章。,阐述各种不同疾病的共同病变基础，属疾病发生的共同规律。如：细胞和组织损伤、损伤的修复、局部血液循环障碍、炎症、肿瘤。,病理学各论,(Systemic Pathology),第,616,章。阐述各器官及器官系统疾,病的特殊规律。,2.Why do we learn Pathology?,a.,认识疾病本质的理论基础,The foundation of medical science and practice,b.,临床疾病诊断的“金标准”,Golden standards for clinic diagnoses,SARS,（非典）,全球最早开展非典（,SARS,）尸检（,4,例）,（,2003,年,2,月,11,日,，,2,月,13,日,，,2,月,25,日,，,5,月,7,日,）,第一例,SARS,尸检现场照片,第三例,SARS,尸检现场照片,4,例,SARS,尸检病理记录资料,首次提出肺部主要病理特征为早期呈脱屑性肺泡炎，晚期呈机化性肺炎的病变过程及病变规律。,脱屑性肺炎改变,机化性肺炎改变,HE,Ag,Ag,肺部主要病理改变,病毒包涵体特殊染色阳性,（,Machiauello,染色,）,透射电镜发现病毒颗粒,为当时临床救治提供直接的指导作用,为进一步明确,SARS,的病因提供了病理学依据,2003,年,2,月,19,日结果,率先提出“非典”系病毒性疾病的观点（,2003,年,2,月,19,日）,首,例,尸,检,初,步,确,定,病,毒,肺,炎,3.How to learn Pathology?,细于观察,勤于思考,勇于质疑,敢于创新,善于循证,幽门螺杆菌,(HP),导致了,80%,到,90%,的胃炎和消化性溃疡,第 一 章,细胞、组织的适应和损伤,Cellular Adaptation&Injury,Adaptive Responses,Cells,Stimulus,Adaptation,Injury,Central theme,适应（,adaptation):,细胞和组织能耐受内外环境中有害因子的刺激而得以存活，并调整其代谢、功能、结构的过程,是对刺激因子的非损伤性应答反应。,Adaptation-,capability of adjusting cellular structure and functions in response to various physiological and pathological conditions.,损伤（,injury):,细胞和组织不能耐受有害因子刺激时引起细胞和组织结构、功能的损害,表现为结构或代谢的异常改变。,Injury-,undergoing certain changes failing to adapt to response to various pathological conditions.,第 一 节,适 应,Cellular adaptation,1.,萎缩(,atrophy),萎缩,(,atrophy),:,己发育正常组织的实质细胞、组织或器官的,体积缩小,，伴有细胞数量的减少,代谢、功能下降。,发育不全,(,hypoplasia,),假性肥大(,pseudohypertrophy,),Atrophy-,decrease in the size or number of cells which results in shrinkage of the organs,.,Causes of atrophy,1.,营养不良性萎缩,(,dystrophic atrophy),2.缺血性萎缩,(,ischemic atrophy),3.,压迫性萎缩,(,compression atrophy),4.,去神经性萎缩,(,neurotic atrophy),5.,废用性萎缩,(,disuse atrophy),6.,内分泌性萎缩,(,endocrine atrophy),缺血性萎缩,(,ischemic atrophy),Due to lack of,blood supply,Brain atrophy,脑回变窄,(narrowing of gyrus),脑沟变宽,(broadening of sulcus),压迫性萎缩,(,Compression atrophy),Tissues are compressed,for long time.,肾积水,(hydronephrosis):,肾盂扩张,(,pyelectasis,),肾实质薄如粉皮,(Thinning of renal parenchyma),Morphology:atrophy,均匀缩小,重量减轻,功能下降,实质细胞体积(数量),间质可增多(假性肥大),细胞器减少退化,自噬小体增多,脂褐素增多,(,细胞器残体,),2.,肥大(,hypertrophy),肥大:,细胞、组织和器官体积的增大代谢、功能增强。,Hypertrophy,-increase in the size of cells which results in enlargement of the organs,Types of hypertrophy,1)代偿性肥大,(,compensatory,hypertrophy),Caused by increased functional demand or by compensation,Types of hypertrophy,2)内分泌性肥大(,endocrine hypertrophy),-Caused by too much hormonal stimulation,-肢端肥大症(,acromegaly,),-巨人症(,Giantism),3.,增生(,hyperplasia),增生,:,组织或器官的实质细胞增多,可伴细胞肥大,Hyperplasia-increased number of cells in an organ or tissue,乳腺小叶增生,(,lobular hyperplasia of breast),Types of hyperplasia,21)内分泌性增生(,endocrine hyperplasia),2),代偿性增生(,compensatory hyperplasia),缺碘 甲状腺增生,4.,化生(,metaplasia),化生(,metaplasia),:,一种分化成熟的细胞类型被另一种分化成熟细胞类型所取代的过程。,Metaplasia-transformation or replacement of one adult cell type with another,鳞 1),鳞状上皮化生,(,squamous,metaplasia,),Columnar ciliated epithelium replaced by,squamous,stratified epithelium.,Types of metaplasia,柱 2),肠上皮化生,(Intestinal,metaplasia,),-In the stomach patches of epithelium are replaced by epithelium with intestinal lining.,Types of metaplasia,3),骨化生,(osseous metaplasia),干细胞基因重新编程(,reprograming),细胞转型性分化,（,transdifferentiation）,只发生于同源性细胞之间,常发生的组织：上皮组织，结缔组织,适应意义：较原组织功能降低，可癌变,小结:化生(,summary),第二节,细胞、组织的损伤(,Cellular injury),一 损伤分类,(,classification),可复性,/,可逆性,（,reversible injury),：,-变性,(,degeneration）,-亚致死性损伤,（,sublethal cell injury）,不可复性,(,irreversible injury):,-细胞死亡,（,cell death),-,不,可逆性,损伤,变性(,degeneration),可复性,/,可逆性损伤,变性,是细胞或间质因代谢障碍而发生的可逆性形态学变化，表现为细胞或间质内有,异常物质,或,正常物质异常增多,。,Degeneration-abnormal storage of some substance in cells or in the,stroma,due to cell damages.,异常物质,正常物质异常增多,小结:变性特征(,features),细胞或组织内异常沉积物,异常物质:原来没有(玻璃样物),正常物质蓄积过多:细胞内水、脂肪,代谢改变或障碍的形态学表现,轻度、非致死性、可复性损伤,功能下降，严重则细胞死亡,1.,细胞水肿,（,cellular swelling）,水变性,(,hydropic degeneration),气球样变,(,ballooning degeneration),细胞内水分,异常增多,Hydropic degeneration-accumulation of water in cell,肿大,胞浆疏松淡染,空泡,大体：,器官体积肿大，,色淡，混浊无光泽,光镜：,细胞体积增大，,或颗粒状,Morphology:,Hydropic degeneration,内质网扩张、囊泡变,核糖体脱失,线粒体肿胀、嵴消失,Morphology:,Hydropic degeneration,hydropic degeneration:,细胞内水分异常增多,细胞肿胀,细小颗粒或空泡,轻度损伤，早期病变,Na-K,泵功能障碍,水钠增多,Key:Impaired Na/K pump,Na is trapped in cell,Water content is increased,2.脂肪变性,(,fatty degeneration）,非脂肪细胞内中性脂肪的蓄积,胞浆内异常脂滴,边缘较整齐的空泡,小泡性,/,大泡性,The accumulation of lipid within the cytoplasm,Morphology:fatty degeneration,脂肪肝,大体：肝肿大,边缘钝,淡黄色,质软,油腻感,Gross:yellow,soft,large,greasy,Fatty degeneration of liver,:,苏丹,III,染色,-,桔红色,Fatty degeneration,of heart,虎斑心,锇酸染色-黑色,区别:心肌脂肪浸润(,fatty infiltration),感染、化学毒物（酒精、四氯化碳）,缺氧,营养障碍，肥胖,中性脂肪合成过多,脂肪酸的氧化障碍,脂肪在细胞内沉积,脂蛋白合成障碍,KEY:,Impaired fat metabolism and intracellular accumulation of fat,Mechanisms:Fatty degeneration,小 结,适应,(,adaptation),损伤,(,injury),萎缩(,atrophy),肥大(,hypertrophy),增生(,hyperplasia),化生(,metaplasia),变性(,degeneration),细胞死亡(,cell death),变性,水变性,脂肪变性,玻璃样变,淀粉样变,粘液变性,病理性色素沉着,病理性钙化,小 结,病理学系,国家重点培育学科 国家重点临床专科,国家级精品课程学科 国家临床病理医师培训基地,