組織病理學(xué)基礎(chǔ)課件

組織病理學(xué)基礎(chǔ)

炎癥

整理課件

組織病理學(xué)基礎(chǔ)

炎癥

整理課件DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying知識(shí)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(diǎn)炎癥的局部表現(xiàn)和全身反應(yīng)炎癥的臨床分型和結(jié)局知識(shí)目標(biāo)整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying一、概述具有血管系統(tǒng)的活體組織對(duì)致炎因子所致局部損害而發(fā)生的以防御為主的反應(yīng)。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(yīng)（血管擴(kuò)張→血漿及白細(xì)胞滲出→局限和消滅損傷因子，清除和吸收壞死組織和細(xì)胞）→實(shí)質(zhì)細(xì)胞和間質(zhì)細(xì)胞再生修復(fù)損傷血管反應(yīng)是炎癥過(guò)程的中心環(huán)節(jié)變質(zhì)增生炎癥過(guò)程炎癥反應(yīng)是如何發(fā)生的？整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying早期變質(zhì)滲出增生損傷性反應(yīng)防御性反應(yīng)晚期整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying炎癥介質(zhì)(inflammatorymediator)定義：

一組參與并誘導(dǎo)炎癥發(fā)生發(fā)展的具有生物活性的化學(xué)物質(zhì)作用：1、促進(jìn)血管反應(yīng)，使血管壁通透性增高2、對(duì)炎細(xì)胞的趨化作用3、引起發(fā)熱、疼痛等整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying炎癥是機(jī)體的一種（）免疫反應(yīng)局部反應(yīng)全身性反應(yīng)防御性反應(yīng)細(xì)菌或病毒反應(yīng)整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying炎癥過(guò)程的中心環(huán)節(jié)是（）A．細(xì)胞和組織的各種損傷B．白細(xì)胞對(duì)損傷因子的吞噬作用C．血管反應(yīng)D．修復(fù)損傷E．實(shí)質(zhì)細(xì)胞和間質(zhì)細(xì)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(xué)性因子C．壞死組織D．生物性因子E．變態(tài)反應(yīng)整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying二、炎癥局部的基本病理變化

變質(zhì)(alteration):

炎癥局部組織或細(xì)胞發(fā)生變性和壞死。促進(jìn)滲出發(fā)生。滲出(exudation):

炎癥灶血管內(nèi)的液體和細(xì)胞成分通過(guò)血管壁進(jìn)入組織間隙、體腔、體表和粘膜表面的過(guò)程。增生(proliferation):

炎癥局部組織內(nèi)的實(shí)質(zhì)細(xì)胞及間質(zhì)細(xì)胞再生。限制炎癥，修復(fù)組織。過(guò)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(xì)胞滲出（炎性浸潤(rùn)）整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying1、炎性充血過(guò)程：1.細(xì)動(dòng)脈短暫痙攣2.動(dòng)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(nèi)含大量蛋白質(zhì)的液體成分通過(guò)血管壁滲出到血管外的過(guò)程。滲出液：炎癥時(shí)從血管內(nèi)滲出的液體炎性水腫：滲出液進(jìn)入組織間隙炎性積液：滲出液在漿膜腔和關(guān)節(jié)腔內(nèi)集聚整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying1）血管壁通透性升高內(nèi)皮細(xì)胞收縮，細(xì)胞間隙增寬內(nèi)皮細(xì)胞損傷，脫落內(nèi)皮細(xì)胞吞飲能力增強(qiáng)新生毛細(xì)血管壁的高通透性（1）液體滲出的機(jī)制整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying2）微血管內(nèi)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(qū)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(zhì)；2.帶來(lái)營(yíng)養(yǎng)物質(zhì)及抗體、補(bǔ)體，帶走代謝產(chǎn)物；3.纖維蛋白網(wǎng)有利于吞噬和修復(fù)；4.刺激機(jī)體發(fā)生體液和細(xì)胞免疫反應(yīng)。不利：壓迫和粘連整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying

白細(xì)胞穿過(guò)血管壁進(jìn)入組織間隙并發(fā)揮吞噬作用，是炎癥防御反應(yīng)的中心環(huán)節(jié)。游出的白細(xì)胞稱為炎細(xì)胞(inflammatorycells)炎細(xì)胞聚集在炎癥區(qū)域的現(xiàn)象稱為炎性浸潤(rùn)。

3.白細(xì)胞滲出---炎性浸潤(rùn)炎癥反應(yīng)最核心的改變整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying

白細(xì)胞滲出是一種主動(dòng)過(guò)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(yùn)動(dòng)的形式進(jìn)行。整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying紅細(xì)胞無(wú)游走能力，它的逸出是被動(dòng)性的滲出液中出現(xiàn)大量紅細(xì)胞，則標(biāo)志著炎癥反應(yīng)劇烈或血管壁損傷嚴(yán)重。整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying炎癥的不同階段，游出的白細(xì)胞不同致炎因子不同，滲出的白細(xì)胞也不同中性粒細(xì)胞急性炎癥早期和化膿性炎單核細(xì)胞急性炎癥后期、肉芽腫性炎淋巴細(xì)胞慢性炎癥、病毒感染漿細(xì)胞慢性炎癥嗜酸性粒細(xì)胞變態(tài)反應(yīng)、寄生蟲感染P63、65整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying關(guān)于趨化（自學(xué)）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(nèi)白細(xì)胞吞噬病原微生物、異物和組織碎片的過(guò)程。吞噬細(xì)胞：1.中性粒細(xì)胞(小吞噬細(xì)胞)2.巨噬細(xì)胞(大吞噬細(xì)胞)：可融合成多核巨細(xì)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(shí)別和粘著2.包圍和吞入3.殺傷和降解

吞噬過(guò)程調(diào)理素：特異性抗體和補(bǔ)體，能增強(qiáng)吞噬細(xì)胞的識(shí)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(xì)菌（如TB）在未激活的白細(xì)胞內(nèi)不易被殺滅，平時(shí)處于靜止?fàn)顟B(tài)，一旦機(jī)體抵抗力下降，又能繁殖，并可隨吞噬細(xì)胞游走而在體內(nèi)播散。整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying炎癥早期血流動(dòng)力學(xué)改變的順序?yàn)?)A．血流減慢→血管擴(kuò)張，血流加速→細(xì)動(dòng)脈短暫收縮→白細(xì)胞附壁B．血管擴(kuò)張，血流加速→細(xì)動(dòng)脈短暫收縮→白細(xì)胞附壁→血流減慢C．細(xì)動(dòng)脈短暫收縮→血流減慢→血管擴(kuò)張，血流加速→白細(xì)胞附壁D．細(xì)動(dòng)脈短暫收縮→血管擴(kuò)張，血流加速→白細(xì)胞附壁→血流減慢E．細(xì)動(dòng)脈短暫收縮→血管擴(kuò)張，血流加速→血流減慢→白細(xì)胞附壁整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying急性炎癥過(guò)程中，最先發(fā)生哪種變化()A．白細(xì)胞游出B．白細(xì)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(xì)胞定向集中的現(xiàn)象稱為()A．白細(xì)胞游出B．白細(xì)胞吞噬C．白細(xì)胞阿米巴運(yùn)動(dòng)D．趨化性E．白細(xì)胞滲出整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying急性炎癥48小時(shí)后病灶中主要的炎性細(xì)胞是（）A．淋巴細(xì)胞B．嗜堿性粒細(xì)胞C．中性粒細(xì)胞D．巨噬細(xì)胞E．肥大細(xì)胞整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying較多嗜酸性粒細(xì)胞浸潤(rùn)見于()A．傷寒桿菌感染B．變態(tài)反應(yīng)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(xì)胞不是通過(guò)變形運(yùn)動(dòng)離開血管的（）A．中性粒細(xì)胞B．紅細(xì)胞C．嗜酸性粒細(xì)胞D．淋巴細(xì)胞E．巨噬細(xì)胞整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying三、炎癥的病理類型變質(zhì)性炎以組織細(xì)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(nèi)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(xì)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(diǎn)是什么？整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying（一）變質(zhì)性炎急性肝炎---肝細(xì)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(diǎn)好發(fā)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(jié)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(xì)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(nèi)臟蜂窩織炎---肌肉、闌尾出血性炎血管損傷嚴(yán)重，滲出物含大量紅細(xì)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(wǎng)狀、條狀或顆粒狀，?；煊兄行粤＜?xì)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(fā)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(fā)生于粘膜的纖維蛋白性炎，滲出的纖維蛋白、中性粒細(xì)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(fā)生于心外膜的纖維蛋白性炎，由于心臟的不斷搏動(dòng)，使?jié)B出在心包臟、壁兩層表面的纖維蛋白形成無(wú)數(shù)絨毛狀物。（2）發(fā)生于漿膜整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying鏡下：纖維蛋白為紅染、網(wǎng)片狀或細(xì)絲狀物，夾雜有一定的中性粒細(xì)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(zhì)地變實(shí)（肝樣變）

（3）發(fā)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(xì)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(xì)胞?整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying類型膿腫多發(fā)生于皮膚和內(nèi)臟局限性,與周圍組織分界清楚蜂窩織炎疏松結(jié)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(nèi)局限性化膿性炎癥。主要特征—組織發(fā)生溶解壞死，形成充滿膿液的腔。好發(fā)部位—皮膚、內(nèi)臟器官病因、發(fā)病機(jī)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(fā)生的膿腫。整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying[癰]癰是多個(gè)癤的融合，在皮下脂肪筋膜組織形成多個(gè)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(jié)締組織的彌漫性化膿性炎好發(fā)部位——皮下、肌肉間、闌尾病變特點(diǎn)——大量中性粒細(xì)胞彌漫浸潤(rùn)，無(wú)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(fā)病機(jī)制——溶血性鏈球菌

透明質(zhì)酸酶→溶解透明質(zhì)酸，細(xì)菌易擴(kuò)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?。?）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(yán)重，滲出物中含大量紅細(xì)胞常與其他炎癥同時(shí)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(xiàn)紅、腫、熱、痛，隨之皮膚上起水泡，其病變屬（）A．變質(zhì)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(shù)切除病變肺組織，巨檢見病變中央呈囊腔狀，腔內(nèi)含黃色膿液，鏡下腔壁可見大量變性壞死中性粒細(xì)胞，可診斷為()A．肺結(jié)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(xì)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(jié)局

（一）臨床分型病程臨床表現(xiàn)病理變化超急性炎癥幾小時(shí)-幾天暴發(fā)性經(jīng)過(guò)，反應(yīng)劇烈組織器官嚴(yán)重?fù)p害，多屬變態(tài)反應(yīng)性炎急性炎癥幾天-1個(gè)月起病急，癥狀明顯以變質(zhì)滲出為主，中性粒細(xì)胞浸潤(rùn)亞急性炎癥1個(gè)月-幾個(gè)月少見，常由急性轉(zhuǎn)變而來(lái)/慢性炎癥幾個(gè)月-幾年起病緩慢，臨床表現(xiàn)不明顯以增生為主，慢性炎細(xì)胞浸潤(rùn)整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying（三）增生性炎以組織細(xì)胞的增生為主的炎癥多為慢性炎癥（2個(gè)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(diǎn)：慢性炎細(xì)胞浸潤(rùn)：巨噬細(xì)胞、淋巴細(xì)胞、漿細(xì)胞血管內(nèi)皮細(xì)胞、成纖維細(xì)胞、上皮細(xì)胞等增生。特殊形態(tài)：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(xì)胞及其演變的細(xì)胞增生為主，形成境界清楚的結(jié)節(jié)狀病灶。病理學(xué)上常能根據(jù)肉芽腫的物殊形態(tài)來(lái)幫助確定炎癥的原因。類型病因/特殊形態(tài)感染性肉芽腫結(jié)核---結(jié)核結(jié)節(jié)：上皮樣細(xì)胞、朗漢斯巨細(xì)胞傷寒---傷寒小結(jié)：傷寒細(xì)胞風(fēng)濕---風(fēng)濕小體：風(fēng)濕細(xì)胞異物肉芽腫硅塵、外科縫線---異物巨細(xì)胞整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying肺粟粒性結(jié)核---結(jié)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(xiàn)和全身反應(yīng)一.局部表現(xiàn)：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(xiàn)？為什么會(huì)有這些臨床表現(xiàn)？整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying二.全身表現(xiàn)：發(fā)熱白細(xì)胞變化單核巨噬細(xì)胞系統(tǒng)增生實(shí)質(zhì)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(jié)局

（一）臨床分型病程臨床表現(xiàn)病理變化超急性炎癥幾小時(shí)-幾天暴發(fā)性經(jīng)過(guò)，反應(yīng)劇烈組織器官嚴(yán)重?fù)p害，多屬變態(tài)反應(yīng)性炎急性炎癥幾天-1個(gè)月起病急，癥狀明顯以變質(zhì)滲出為主，中性粒細(xì)胞浸潤(rùn)亞急性炎癥1個(gè)月-幾個(gè)月少見，常由急性轉(zhuǎn)變而來(lái)/慢性炎癥幾個(gè)月-幾年起病緩慢，臨床表現(xiàn)不明顯以增生為主，慢性炎細(xì)胞浸潤(rùn)整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying（二）炎癥的結(jié)局痊愈遷延不愈轉(zhuǎn)為慢性蔓延擴(kuò)散局部蔓延淋巴道擴(kuò)散血道擴(kuò)散炎癥的結(jié)局如何？整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying血道擴(kuò)散(1)菌血癥(bacteremia)

血液中有細(xì)菌，但無(wú)明顯癥狀。(2)毒血癥(toxemia)

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

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

敗血癥+多發(fā)性栓塞性膿腫。小膿腫中央的血管中可見細(xì)菌菌落。整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying患者女性，39歲，因經(jīng)量增多，淋漓不盡行診刮術(shù)。送檢內(nèi)膜組織鏡下見子宮內(nèi)膜間質(zhì)中大量漿細(xì)胞浸潤(rùn)，應(yīng)診斷為()A．急性子宮內(nèi)膜炎B．慢性子宮內(nèi)膜炎C．子宮內(nèi)膜結(jié)核D．子宮內(nèi)膜單純性增生E．以上均不是整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying大量細(xì)菌毒素入血，導(dǎo)致實(shí)質(zhì)細(xì)胞變性、壞死及全身中毒癥狀的稱()A．菌血癥B．毒血癥C．?dāng)⊙YD．白血病E．膿毒血癥整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying下列哪項(xiàng)不是敗血癥的表現(xiàn)()A．細(xì)菌入血并產(chǎn)生毒素B．高熱寒戰(zhàn)C．一些內(nèi)臟器官的多發(fā)性小膿腫D．皮膚．黏膜點(diǎn)狀出血E．脾腫大整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying學(xué)習(xí)目標(biāo)掌握：炎癥、炎癥介質(zhì)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(xì)胞的作用；常見的炎癥類型及形態(tài)特點(diǎn)。熟悉：炎癥滲出的過(guò)程、滲出液與漏出液的區(qū)別、白細(xì)胞的滲出過(guò)程；炎癥的局部表現(xiàn)和全身反應(yīng)；炎癥的臨床分型及結(jié)局。了解：炎癥的原因，炎癥介質(zhì)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(zhì)、滲出、趨化作用、假膜性炎、絨毛心、肉芽腫性炎二、問(wèn)答題：炎癥的基本病理變化有哪些？他們之間關(guān)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(diǎn)？整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying第三節(jié)腫瘤預(yù)習(xí)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(zhuǎn)移？腫瘤對(duì)機(jī)體有何影響？如何區(qū)分良性腫瘤和惡性腫瘤？如何早期發(fā)現(xiàn)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(qū)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(jī)理分泌血漿凝固酶分泌透明質(zhì)酸酶好發(fā)部位皮下、內(nèi)臟皮膚、肌肉、闌尾病變特點(diǎn)膿腔形成組織內(nèi)水腫、中性粒細(xì)胞浸潤(rùn)炎癥分界清不清中毒癥狀較輕較重修復(fù)瘢痕修復(fù)不留瘢痕整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying細(xì)菌入血繁殖產(chǎn)生毒素血中查細(xì)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(xué)基礎(chǔ)

炎癥

整理課件

組織病理學(xué)基礎(chǔ)

炎癥

整理課件DepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying知識(shí)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(diǎn)炎癥的局部表現(xiàn)和全身反應(yīng)炎癥的臨床分型和結(jié)局知識(shí)目標(biāo)整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying一、概述具有血管系統(tǒng)的活體組織對(duì)致炎因子所致局部損害而發(fā)生的以防御為主的反應(yīng)。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(yīng)（血管擴(kuò)張→血漿及白細(xì)胞滲出→局限和消滅損傷因子，清除和吸收壞死組織和細(xì)胞）→實(shí)質(zhì)細(xì)胞和間質(zhì)細(xì)胞再生修復(fù)損傷血管反應(yīng)是炎癥過(guò)程的中心環(huán)節(jié)變質(zhì)增生炎癥過(guò)程炎癥反應(yīng)是如何發(fā)生的？整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying早期變質(zhì)滲出增生損傷性反應(yīng)防御性反應(yīng)晚期整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying炎癥介質(zhì)(inflammatorymediator)定義：

一組參與并誘導(dǎo)炎癥發(fā)生發(fā)展的具有生物活性的化學(xué)物質(zhì)作用：1、促進(jìn)血管反應(yīng)，使血管壁通透性增高2、對(duì)炎細(xì)胞的趨化作用3、引起發(fā)熱、疼痛等整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying炎癥是機(jī)體的一種（）免疫反應(yīng)局部反應(yīng)全身性反應(yīng)防御性反應(yīng)細(xì)菌或病毒反應(yīng)整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying炎癥過(guò)程的中心環(huán)節(jié)是（）A．細(xì)胞和組織的各種損傷B．白細(xì)胞對(duì)損傷因子的吞噬作用C．血管反應(yīng)D．修復(fù)損傷E．實(shí)質(zhì)細(xì)胞和間質(zhì)細(xì)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(xué)性因子C．壞死組織D．生物性因子E．變態(tài)反應(yīng)整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying二、炎癥局部的基本病理變化

變質(zhì)(alteration):

炎癥局部組織或細(xì)胞發(fā)生變性和壞死。促進(jìn)滲出發(fā)生。滲出(exudation):

炎癥灶血管內(nèi)的液體和細(xì)胞成分通過(guò)血管壁進(jìn)入組織間隙、體腔、體表和粘膜表面的過(guò)程。增生(proliferation):

炎癥局部組織內(nèi)的實(shí)質(zhì)細(xì)胞及間質(zhì)細(xì)胞再生。限制炎癥，修復(fù)組織。過(guò)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(xì)胞滲出（炎性浸潤(rùn)）整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying1、炎性充血過(guò)程：1.細(xì)動(dòng)脈短暫痙攣2.動(dòng)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(nèi)含大量蛋白質(zhì)的液體成分通過(guò)血管壁滲出到血管外的過(guò)程。滲出液：炎癥時(shí)從血管內(nèi)滲出的液體炎性水腫：滲出液進(jìn)入組織間隙炎性積液：滲出液在漿膜腔和關(guān)節(jié)腔內(nèi)集聚整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying1）血管壁通透性升高內(nèi)皮細(xì)胞收縮，細(xì)胞間隙增寬內(nèi)皮細(xì)胞損傷，脫落內(nèi)皮細(xì)胞吞飲能力增強(qiáng)新生毛細(xì)血管壁的高通透性（1）液體滲出的機(jī)制整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying2）微血管內(nèi)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(qū)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(zhì)；2.帶來(lái)營(yíng)養(yǎng)物質(zhì)及抗體、補(bǔ)體，帶走代謝產(chǎn)物；3.纖維蛋白網(wǎng)有利于吞噬和修復(fù)；4.刺激機(jī)體發(fā)生體液和細(xì)胞免疫反應(yīng)。不利：壓迫和粘連整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying

白細(xì)胞穿過(guò)血管壁進(jìn)入組織間隙并發(fā)揮吞噬作用，是炎癥防御反應(yīng)的中心環(huán)節(jié)。游出的白細(xì)胞稱為炎細(xì)胞(inflammatorycells)炎細(xì)胞聚集在炎癥區(qū)域的現(xiàn)象稱為炎性浸潤(rùn)。

3.白細(xì)胞滲出---炎性浸潤(rùn)炎癥反應(yīng)最核心的改變整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying

白細(xì)胞滲出是一種主動(dòng)過(guò)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(yùn)動(dòng)的形式進(jìn)行。整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying紅細(xì)胞無(wú)游走能力，它的逸出是被動(dòng)性的滲出液中出現(xiàn)大量紅細(xì)胞，則標(biāo)志著炎癥反應(yīng)劇烈或血管壁損傷嚴(yán)重。整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying炎癥的不同階段，游出的白細(xì)胞不同致炎因子不同，滲出的白細(xì)胞也不同中性粒細(xì)胞急性炎癥早期和化膿性炎單核細(xì)胞急性炎癥后期、肉芽腫性炎淋巴細(xì)胞慢性炎癥、病毒感染漿細(xì)胞慢性炎癥嗜酸性粒細(xì)胞變態(tài)反應(yīng)、寄生蟲感染P63、65整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying關(guān)于趨化（自學(xué)）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(nèi)白細(xì)胞吞噬病原微生物、異物和組織碎片的過(guò)程。吞噬細(xì)胞：1.中性粒細(xì)胞(小吞噬細(xì)胞)2.巨噬細(xì)胞(大吞噬細(xì)胞)：可融合成多核巨細(xì)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(shí)別和粘著2.包圍和吞入3.殺傷和降解

吞噬過(guò)程調(diào)理素：特異性抗體和補(bǔ)體，能增強(qiáng)吞噬細(xì)胞的識(shí)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(xì)菌（如TB）在未激活的白細(xì)胞內(nèi)不易被殺滅，平時(shí)處于靜止?fàn)顟B(tài)，一旦機(jī)體抵抗力下降，又能繁殖，并可隨吞噬細(xì)胞游走而在體內(nèi)播散。整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying炎癥早期血流動(dòng)力學(xué)改變的順序?yàn)?)A．血流減慢→血管擴(kuò)張，血流加速→細(xì)動(dòng)脈短暫收縮→白細(xì)胞附壁B．血管擴(kuò)張，血流加速→細(xì)動(dòng)脈短暫收縮→白細(xì)胞附壁→血流減慢C．細(xì)動(dòng)脈短暫收縮→血流減慢→血管擴(kuò)張，血流加速→白細(xì)胞附壁D．細(xì)動(dòng)脈短暫收縮→血管擴(kuò)張，血流加速→白細(xì)胞附壁→血流減慢E．細(xì)動(dòng)脈短暫收縮→血管擴(kuò)張，血流加速→血流減慢→白細(xì)胞附壁整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying急性炎癥過(guò)程中，最先發(fā)生哪種變化()A．白細(xì)胞游出B．白細(xì)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(xì)胞定向集中的現(xiàn)象稱為()A．白細(xì)胞游出B．白細(xì)胞吞噬C．白細(xì)胞阿米巴運(yùn)動(dòng)D．趨化性E．白細(xì)胞滲出整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying急性炎癥48小時(shí)后病灶中主要的炎性細(xì)胞是（）A．淋巴細(xì)胞B．嗜堿性粒細(xì)胞C．中性粒細(xì)胞D．巨噬細(xì)胞E．肥大細(xì)胞整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying較多嗜酸性粒細(xì)胞浸潤(rùn)見于()A．傷寒桿菌感染B．變態(tài)反應(yīng)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(xì)胞不是通過(guò)變形運(yùn)動(dòng)離開血管的（）A．中性粒細(xì)胞B．紅細(xì)胞C．嗜酸性粒細(xì)胞D．淋巴細(xì)胞E．巨噬細(xì)胞整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying三、炎癥的病理類型變質(zhì)性炎以組織細(xì)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(nèi)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(xì)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(diǎn)是什么？整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying（一）變質(zhì)性炎急性肝炎---肝細(xì)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(diǎn)好發(fā)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(jié)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(xì)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(nèi)臟蜂窩織炎---肌肉、闌尾出血性炎血管損傷嚴(yán)重，滲出物含大量紅細(xì)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(wǎng)狀、條狀或顆粒狀，?；煊兄行粤＜?xì)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(fā)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(fā)生于粘膜的纖維蛋白性炎，滲出的纖維蛋白、中性粒細(xì)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(fā)生于心外膜的纖維蛋白性炎，由于心臟的不斷搏動(dòng)，使?jié)B出在心包臟、壁兩層表面的纖維蛋白形成無(wú)數(shù)絨毛狀物。（2）發(fā)生于漿膜整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying鏡下：纖維蛋白為紅染、網(wǎng)片狀或細(xì)絲狀物，夾雜有一定的中性粒細(xì)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(zhì)地變實(shí)（肝樣變）

（3）發(fā)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(xì)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(xì)胞?整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying類型膿腫多發(fā)生于皮膚和內(nèi)臟局限性,與周圍組織分界清楚蜂窩織炎疏松結(jié)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(nèi)局限性化膿性炎癥。主要特征—組織發(fā)生溶解壞死，形成充滿膿液的腔。好發(fā)部位—皮膚、內(nèi)臟器官病因、發(fā)病機(jī)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(fā)生的膿腫。整理課件DepartmentofPathology，ShaoxDepartmentofPathology，ShaoxingUniversityMedicalCollege，ZhangQiao-ying[癰]癰是多個(gè)癤的融合，在皮下脂肪筋膜組織形成多個(gè)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(jié)締組織的彌漫性化膿性炎好發(fā)部位——皮下、肌肉間、闌尾病變特點(diǎn)——大量中性粒細(xì)胞彌漫浸潤(rùn)，無(wú)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(fā)病機(jī)制——溶血性鏈球菌

透明質(zhì)酸酶→溶解透明質(zhì)酸，細(xì)菌易擴(kuò)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?。?）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(yán)重，滲出物中含大量紅細(xì)胞常與其他炎癥同時(shí)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