呼吸系統(tǒng)教學資料-呼吸病理_zhou_中文版ppt課件

1、Pathology of Respiratory SystemMeiyi ZhouAssistant Professor, Department of PathophysiologySJTU, School of MedicineEtiology, Pathogenesis, Pathological changes, and Complications;Common Diseases in the pulmonary system COPD慢性支氣管炎、肺氣腫慢性支氣管炎、肺氣腫 Infection 肺炎肺炎 Silicosis硅肺硅肺 Chronic Cor Pulmonale肺心病肺心病

2、 Lung Cancer肺癌肺癌 Tuberculosis肺結核肺結核;Chronic Obstructive pulmonary Disease (COPD)DefinationCOPD, namely chronic bronchitis and emphysema, are diseases origination in the airways or notably affect in airway function. 慢性阻塞性肺病慢性阻塞性肺病COPD指由于氣道完全指由于氣道完全或不完全阻塞，導致通氣阻力添加及肺功能或不完全阻塞，導致通氣阻力添加及肺功能不全的慢性肺疾病。包括慢性支氣

3、管炎和肺不全的慢性肺疾病。包括慢性支氣管炎和肺氣腫。氣腫。;Chronic bronchitis is defined on clinical grounds alone, as the presence of chronic productive cough for 3 months in 2 successive years, in the absence of any other explanation for this symptom.指氣管、支氣管黏膜及其周圍組織的慢性炎癥。指氣管、支氣管黏膜及其周圍組織的慢性炎癥。臨床特征為反復發(fā)作的咳嗽、咳痰、喘息，病程臨床特征為反復發(fā)作的咳嗽、

4、咳痰、喘息，病程長。如每年發(fā)作時間起過長。如每年發(fā)作時間起過3個月延續(xù)兩年以上者，個月延續(xù)兩年以上者，可診斷為慢性支氣管炎?？稍\斷為慢性支氣管炎。Chronic bronchitis (慢性支氣管炎慢性支氣管炎);Chronic bronchitis (慢性支氣管炎慢性支氣管炎)Etiology病因?qū)W病因?qū)W 理化要素：理化要素： 長期吸煙、空氣污染長期吸煙、空氣污染 氣候要素氣候要素 過敏要素過敏要素 感染要素：感染要素： 病毒、細菌病毒、細菌;Chronic bronchitis (慢性支氣管炎慢性支氣管炎)Pathological Changes病理改動病理改動纖毛粘連、倒伏、脫失纖毛粘連

5、、倒伏、脫失粘膜上皮細胞變性壞死粘膜上皮細胞變性壞死柱狀上皮出現(xiàn)鱗狀上皮柱狀上皮出現(xiàn)鱗狀上皮化生化生 杯狀細胞增多杯狀細胞增多壁增厚壁增厚腺體增生、肥大、粘液化腺體增生、肥大、粘液化;Chapter : Chronic bronchitis (慢性支氣管炎慢性支氣管炎)1.1.粘膜上皮的損傷與修復粘膜上皮的損傷與修復2.2.腺體增生、肥大、粘液化腺體增生、肥大、粘液化3.3.管壁炎癥反響管壁炎癥反響 粘膜、粘膜下層充血、水腫粘膜、粘膜下層充血、水腫 淋巴、漿細胞等浸潤淋巴、漿細胞等浸潤4.4.管壁其他損害管壁其他損害 喘息型患者粘膜下層平滑肌增生、肥大，支氣喘息型患者粘膜下層平滑肌增生、肥大，

6、支氣管變窄，管壁軟骨變性、纖維化、鈣化或骨化管變窄，管壁軟骨變性、纖維化、鈣化或骨化Pathological Changes病理改動病理改動;Squamous metaplasia of chronic bronchitis Chronic bronchitis (慢性支氣管炎慢性支氣管炎);粘液腺增生，漿液腺粘液化粘液腺增生，漿液腺粘液化Chronic bronchitis (慢性支氣管炎慢性支氣管炎);臨床病理聯(lián)絡臨床病理聯(lián)絡咳嗽：支氣管粘膜充血、水腫及粘液分泌物增多咳嗽：支氣管粘膜充血、水腫及粘液分泌物增多 刺激支氣管粘膜引起。刺激支氣管粘膜引起?？忍悼忍? :咳大量白色粘痰或漿液泡沫狀

7、，如伴細菌咳大量白色粘痰或漿液泡沫狀，如伴細菌 感染為膿性：粘液腺增生、肥大；部分感染為膿性：粘液腺增生、肥大；部分 漿液腺化生成粘液腺，粘液分泌增多而致漿液腺化生成粘液腺，粘液分泌增多而致氣喘：因支氣管炎癥，刺激支氣管痙攣或粘液阻氣喘：因支氣管炎癥，刺激支氣管痙攣或粘液阻 塞而致。塞而致。Chronic bronchitis (慢性支氣管炎慢性支氣管炎);并發(fā)癥并發(fā)癥 支氣管擴張：長期支氣管炎癥的破壞， 其彈力性和支撐力減弱，加之長 期的咳嗽而致。 肺氣腫：管腔內(nèi)粘液潴留及粘液栓形 成，使末梢肺組織過度充氣而致。 肺心?。悍螝饽[引起肺間隔破壞，肺 動脈高壓，右心室肥大、擴張。 支氣管肺炎：支

8、氣管壁甚薄，炎癥易于 分散而累及肺泡。Chronic bronchitis (慢性支氣管炎慢性支氣管炎);Emphysema (肺氣腫肺氣腫)Defination指呼吸性細支氣管至肺泡的末梢肺組織因繼續(xù)性指呼吸性細支氣管至肺泡的末梢肺組織因繼續(xù)性含氣量添加而呈永久性過度膨脹，伴有肺泡壁彈含氣量添加而呈永久性過度膨脹，伴有肺泡壁彈力組織破壞，間隔斷裂致肺泡相互交融，肺容積力組織破壞，間隔斷裂致肺泡相互交融，肺容積增大的病理形狀。增大的病理形狀。病因和發(fā)病機理病因和發(fā)病機理阻塞性通氣妨礙阻塞性通氣妨礙1抗胰蛋白酶缺乏抗胰蛋白酶缺乏;Emphysema (肺氣腫肺氣腫)類型類型 肺泡性肺氣腫肺泡性肺

9、氣腫 (Alveolar emphysema) 腺泡中央型腺泡中央型 (Centriacinar emphysema), 吸煙相關吸煙相關 全腺泡型全腺泡型 (Panacinar emphysema), 1 - Antitrypsin 腺泡周圍型腺泡周圍型 (Periacinar emphysema), 青年人可見青年人可見 不規(guī)那么型不規(guī)那么型 (Irregular emphsema), 瘢痕旁肺氣腫瘢痕旁肺氣腫 肺氣腫樣病變：肺氣腫樣病變： 肺大泡肺大泡 間質(zhì)性肺氣腫間質(zhì)性肺氣腫 (Interstitial emphysema)類型類型; 煙民常見煙民常見, 上中葉病變?yōu)樯现腥~病變?yōu)橹髦?

10、最嚴重最嚴重, 下葉病變?yōu)橹飨氯~病變?yōu)橹餍啬は虏∽優(yōu)橹餍啬は虏∽優(yōu)橹?部分片灶性病變部分片灶性病變 ;Emphysema (肺氣腫肺氣腫)大體：大體： 體積增大，邊緣鈍圓，灰白色，柔體積增大，邊緣鈍圓，灰白色，柔軟彈性差，切面海綿狀。外表?？梢娎哕洀椥圆?，切面海綿狀。外表?？梢娎吖菈汉?，壓痕不易衰退。觸之捻發(fā)音加骨壓痕，壓痕不易衰退。觸之捻發(fā)音加強。強。 ;擴張的肺泡交融成較大的囊腔，間隔變窄，肺泡擴張的肺泡交融成較大的囊腔，間隔變窄，肺泡孔擴展，間隔斷裂孔擴展，間隔斷裂Emphysema (肺氣腫肺氣腫);Localized Emphysema Irregular EmphysemaEmph

11、ysema (肺氣腫肺氣腫);Bullae ( 肺大泡肺大泡, 1cm )( 相關病變：腺泡周圍型肺氣腫相關病變：腺泡周圍型肺氣腫 )Emphysema (肺氣腫肺氣腫);Pneumonia (肺炎肺炎)DefinationPulmonary infections are in the form of pneumonia, which is common disease in respiratory system.指肺組織的急性滲出性炎癥，是呼吸系統(tǒng)的指肺組織的急性滲出性炎癥，是呼吸系統(tǒng)的常見病。常見病。;Pneumonia (肺炎肺炎)Classification Pathogen病因病因

12、Infection bacteria, virus, fungal, mycoplasmal Physics & chemistry radio, inhaling materials Allergy hypersusceptibility, rheumatism Lesion position and range累及部位累及部位 lobar, lobular, interstitial Type of inflammation感染類型感染類型 serous, fibrinous, hemorrhagic, caseous, granulomatous ;Lobar Pneumonia

13、 (大葉性肺炎大葉性肺炎)DefinationLobar pneumonia is an acute fibrinous inflammation in alveoli. Although originally occurred in alveoli, it would spread into a whole lobe or more lobes rapidly. In general, young adults are involved in this type of pneumonia.指肺泡內(nèi)以纖維素滲出為主的急性炎癥，病指肺泡內(nèi)以纖維素滲出為主的急性炎癥，病變始于肺泡，迅速涉及一個肺段

14、或整個大葉，變始于肺泡，迅速涉及一個肺段或整個大葉，多見于青壯年。多見于青壯年。;Lobar Pneumonia (大葉性肺炎大葉性肺炎)Symptoms high fever, shaking chills cough rusty sputum鐵銹色痰鐵銹色痰 chest pain dyspnea, cyanosis rales with consolidation presentations;Lobar Pneumonia (大葉性肺炎大葉性肺炎)Etiolgoy pathogen - s t r e p t o c o c c u s pneumoiae (肺炎鏈球菌肺炎鏈球菌) - s

15、taphylococcus (葡萄葡萄球菌球菌) - h e m o p h i l u s influenzae (流感嗜血桿菌流感嗜血桿菌) inducing factors - cold - excessive tired - anesthesia;Lobar Pneumonia (大葉性肺炎大葉性肺炎)Pathogenesis發(fā)病機制發(fā)病機制Permeability of cap.Serous and fibrinous exudationProliferation of bacteriaLobar pneumonia (7-10 days);Lobar Pneumonia (大葉性肺

16、炎大葉性肺炎)Morphology - Gross ViewCited from Robbins Basic Pathology (9th Edition) Page 489;Lobar Pneumonia (大葉性肺炎大葉性肺炎) 肺泡壁血管充血，肺泡壁血管充血，肺泡腔漿液滲出。肺泡腔漿液滲出。臨床可出現(xiàn)濕性臨床可出現(xiàn)濕性羅音，線呈淺羅音，線呈淺薄均勻的陰影。薄均勻的陰影。Phase : Congestion and Edema充血水腫充血水腫 1-2 days;暗紅、腫大、切面能擠出淡紅色泡沫狀液體暗紅、腫大、切面能擠出淡紅色泡沫狀液體Lobar Pneumonia (大葉性肺炎大葉性肺炎

17、)Phase : Congestion and Edema充血水腫充血水腫 1-2 days; 肺泡壁血管顯著充血，肺泡壁血管顯著充血，肺泡腔充溢大量纖維蛋白肺泡腔充溢大量纖維蛋白和紅細胞，肺組織實變、和紅細胞，肺組織實變、色暗紅如肝。色暗紅如肝。 病人開場咳鐵銹色痰，病人開場咳鐵銹色痰，常伴胸痛、呼吸困難等。常伴胸痛、呼吸困難等。有肺實變征。線見大片有肺實變征。線見大片均勻致密陰影。均勻致密陰影。Phase : Red Hepatization (紅色肝變期紅色肝變期) 3-4 daysLobar Pneumonia (大葉性肺炎大葉性肺炎);暗紅色、腫大暗紅色、腫大質(zhì)地變實像肝臟質(zhì)地變實像

18、肝臟切面粗糙呈顆粒狀切面粗糙呈顆粒狀Lobar Pneumonia (大葉性肺炎大葉性肺炎)Phase : Red Hepatization (紅色肝變期紅色肝變期) 3-4 days;Phase : Gray Hepatization (灰色肝變期灰色肝變期) 5-6 days 肺泡壁血管肺泡壁血管受壓迫，肺泡腔受壓迫，肺泡腔內(nèi)充溢大量纖維內(nèi)充溢大量纖維蛋白網(wǎng)，中性白蛋白網(wǎng)，中性白細胞。肺葉灰白，細胞。肺葉灰白，實變?nèi)绺?。病人實變?nèi)绺?。病人仍有肺實變體征。仍有肺實變體征。Lobar Pneumonia (大葉性肺炎大葉性肺炎);腫大、灰白、切面枯燥腫大、灰白、切面枯燥Lobar Pneumo

19、nia (大葉性肺炎大葉性肺炎)Phase : Gray Hepatization (灰色肝變期灰色肝變期) 5-6 days;Phase : Resolution溶解散失期溶解散失期 7-10 days 中性白細胞崩解，中性白細胞崩解，放出蛋白酶，溶放出蛋白酶，溶解纖維蛋白；巨解纖維蛋白；巨噬細胞增多，吞噬細胞增多，吞噬活潑，滲出物噬活潑，滲出物逐漸吸收，肺組逐漸吸收，肺組織復原?？棌驮?。Lobar Pneumonia (大葉性肺炎大葉性肺炎);Lobar Pneumonia (大葉性肺炎大葉性肺炎)Complications并發(fā)癥并發(fā)癥Carnification (肺肉量變肺肉量變) Fi

20、brinous exudations from lobar pneumonia converted into granulation tissues because of the deficiency of proteases , which is normally secreted by neutrophils.Abscess(膿腫膿腫)、empyema (化膿性胸膜炎化膿性胸膜炎)fibrinous pleurisy (纖維素性胸膜炎纖維素性胸膜炎)septicemia (敗血癥敗血癥) or pyosepticemia (膿毒敗血癥膿毒敗血癥)infectious shock;Lobar

21、 Pneumonia (大葉性肺炎大葉性肺炎)肺肉量變肺肉量變肺膿腫肺膿腫膿胸膿胸;Lobular Pneumonia (小葉性肺炎小葉性肺炎)DefinationThis type of pulmonary infection can induce purulent exudation mainly occurred in lobule arounding the bronchiole. So it is also defined as bronchopneumonia. It is much more prevalent at the infancies, the extremes of

22、age.常作為一種并發(fā)癥出現(xiàn)，多見于小兒、老人常作為一種并發(fā)癥出現(xiàn)，多見于小兒、老人與體弱者。病變起始于細支氣管，以肺小葉與體弱者。病變起始于細支氣管，以肺小葉為單位，以支氣管為中凡的肺組織化膿性炎為單位，以支氣管為中凡的肺組織化膿性炎癥。癥。 ;Lobular Pneumonia (小葉性肺炎小葉性肺炎)Pathology and PathogenesisMixed infection by many weak bacteria, such as staphylococus and pseudomonas aeruginosa由多種細菌混合感染引起。由多種細菌混合感染引起。symptomsF

23、ever, cough, mucopurulent sputum, dyspnea, cyanosis ;Lobular Pneumonia (小葉性肺炎小葉性肺炎)Morphology - Gross ViewCited from Wikicommon Media;Lobular Pneumonia (小葉性肺炎小葉性肺炎)Morphology - Microscopical structure細支氣管粘膜充血，上皮細支氣管粘膜充血，上皮 壞死、零落，管腔內(nèi)充溢壞死、零落，管腔內(nèi)充溢嗜中性粒細胞、崩解的上嗜中性粒細胞、崩解的上皮細胞及滲出液皮細胞及滲出液病灶周圍肺組織充血、水病灶周圍肺組織充

24、血、水腫腫代償性肺氣腫代償性肺氣腫;Lobular Pneumonia (小葉性肺炎小葉性肺炎);Lobular Pneumonia (小葉性肺炎小葉性肺炎);Lobular Pneumonia (小葉性肺炎小葉性肺炎);Complications Respiratory failure Heart failure Abscess (膿腫膿腫) Empyema (膿胸膿胸) Pyosepticemia (膿毒血癥膿毒血癥) BronchiectasisLobular Pneumonia (小葉性肺炎小葉性肺炎);Difference between Lobar pneumonia and br

25、onchopneumonia;Lobar PneumoniaLobular PneumoniaPathogenstreptococcus pneumoiae mixed bacteriaAgeyoung adultinfancies, oldes, patientsPositionsingle lobebilateral and basalComplicationcartificationpulmonary failure, heart failureGross Viewwhole lobe,hepatizationscattered, small, red or yellowMicrosco

26、py Structurefibrouspurulent;Interstitial Pneumonia (間質(zhì)性肺炎間質(zhì)性肺炎)DefinationThe interstitial pneumonia was an acute respiratory disease characterized by patchy inflammatory changes in the alveolar septa and pulmonary interstitium. Pathogens mycoplasma pneumoniae are the most common children and young adults were usually involved vi