组织病理学基础课件

组织病理学基础炎症Department of Pathology，Shaoxing University Medical College，Zhang Qiao-ying 组织病理学基础 炎症Department of Department of Pathology，Shaoxing University Medical College，Zhang Qiao-ying知识框架知识框架v概述概述v炎症局部的基本病理变化炎症局部的基本病理变化v炎症的类型及病理变化特点炎症的类型及病理变化特点v炎症的局部表现和全身反应炎症的局部表现和全身反应v炎症的临床分型和结局炎症的临床分型和结局知识目标Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying一、概述一、概述v具有具有血管系统血管系统的活体组织对致炎因的活体组织对致炎因子所致局部损害而发生的子所致局部损害而发生的以防御为以防御为主主的反应。的反应。v致炎因子？致炎因子？v最常见的致炎因子？最常见的致炎因子？v感染？感染？什么是炎症？什么是炎症？Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingv致炎因子引起致炎因子引起损伤损伤性变化性变化血管反血管反应应（血管扩张（血管扩张血浆及白细胞血浆及白细胞渗出渗出局限和消灭损伤因子，清除和吸局限和消灭损伤因子，清除和吸收坏死组织和细胞）收坏死组织和细胞）实质细胞和实质细胞和间质细胞间质细胞再生修复再生修复损伤损伤v血管反应是炎症过程的中心环节血管反应是炎症过程的中心环节变质变质增生增生炎症过程炎症过程炎症反应是如何发生的？炎症反应是如何发生的？Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying早期早期变质变质渗出渗出增生增生损伤性反应损伤性反应防御性反应防御性反应晚期晚期Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying炎症介质炎症介质(inflammatory mediator)v定义：定义：一组参与并诱导炎症发生发展的具有生一组参与并诱导炎症发生发展的具有生物活性的化学物质物活性的化学物质 v作用：作用：1、促进血管反应，使血管壁通透性增高、促进血管反应，使血管壁通透性增高2、对炎细胞的趋化作用、对炎细胞的趋化作用3、引起发热、疼痛等、引起发热、疼痛等Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying炎症是机体的一种（）A.免疫反应B.局部反应C.全身性反应D.防御性反应E.细菌或病毒反应Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying炎症过程的中心环节是（）A细胞和组织的各种损伤 B白细胞对损伤因子的吞噬作用C血管反应 D修复损伤 E实质细胞和间质细胞增生Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying炎症最常见的病因是（）A物理性因子 B化学性因子 C坏死组织 D生物性因子 E变态反应Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying二、炎症局部的基本病理变化二、炎症局部的基本病理变化v 变质变质(alteration):炎症局部组织或细胞发生炎症局部组织或细胞发生变性变性和和坏死坏死。促进渗出发生促进渗出发生。v 渗出渗出(exudation):炎症灶血管内的液体和细胞成分通过血管壁进入组织间炎症灶血管内的液体和细胞成分通过血管壁进入组织间隙、体腔、体表和粘膜表面的过程。隙、体腔、体表和粘膜表面的过程。v增生增生(proliferation):炎症局部组织内的实质细胞及间质细胞再生。限制炎症，炎症局部组织内的实质细胞及间质细胞再生。限制炎症，修复组织。过度增生破坏组织，影响功能。修复组织。过度增生破坏组织，影响功能。炎症局部有哪些基本病理变化？炎症局部有哪些基本病理变化？Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying(二二)渗出渗出 1.血流和血管口径的变化（炎性充血）血流和血管口径的变化（炎性充血）2.液体渗出液体渗出（炎性水肿）（炎性水肿）3.白细胞渗出白细胞渗出（炎性浸润）（炎性浸润）Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying1、炎性充血、炎性充血过程：过程：1.细动脉短暂痉挛细动脉短暂痉挛2.动脉性充血动脉性充血3.静脉性充血静脉性充血Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying2、液体渗出、液体渗出-炎性水肿炎性水肿 液体渗出：血管内含大量蛋白质的液体成分通液体渗出：血管内含大量蛋白质的液体成分通过血管壁渗出到血管外的过程。过血管壁渗出到血管外的过程。渗渗 出出 液：液：炎症时从血管内渗出的液体炎症时从血管内渗出的液体 炎性水肿：炎性水肿：渗出液进入组织间隙渗出液进入组织间隙 炎性积液：炎性积液：渗出液在浆膜腔和关节腔内集聚渗出液在浆膜腔和关节腔内集聚Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying1）血管壁通透性升高v内皮细胞收缩，细胞间隙增宽v内皮细胞损伤，脱落v内皮细胞吞饮能力增强v新生毛细血管壁的高通透性（1）液体渗出的机制液体渗出的机制Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying2）微血管内流体静压升高3）组织渗透压升高Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying（2 2）渗出液与漏出液的区别）渗出液与漏出液的区别表表4-14-1Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying（3）渗出液的作用）渗出液的作用有利：有利：v1.稀释毒素及有害物质；稀释毒素及有害物质；v2.带来营养物质及抗体、补体，带走代谢产物；带来营养物质及抗体、补体，带走代谢产物；v3.纤维蛋白网有利于吞噬和修复；纤维蛋白网有利于吞噬和修复；v4.刺激机体发生体液和细胞免疫反应。刺激机体发生体液和细胞免疫反应。不不 利：利：v压迫和粘连压迫和粘连Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingv白细胞穿过血管壁进入组织间隙并发挥吞噬作白细胞穿过血管壁进入组织间隙并发挥吞噬作用，是用，是炎症防御反应的中心环节。炎症防御反应的中心环节。v游出的白细胞称为炎细胞游出的白细胞称为炎细胞(inflammatory cells)v炎细胞聚集在炎症区域的现象称为炎性浸润。炎细胞聚集在炎症区域的现象称为炎性浸润。3.白细胞渗出白细胞渗出-炎性浸润炎性浸润炎症反应最炎症反应最核心的改变核心的改变Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingv 白细胞渗出是一种白细胞渗出是一种主动过程主动过程v 大致步骤如下：大致步骤如下：（1）靠边和附壁）靠边和附壁 （2）游出和趋化）游出和趋化 以以阿米巴样运动阿米巴样运动的形式进行。的形式进行。Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingp 红细胞红细胞无游走能力，它的逸出是无游走能力，它的逸出是被动性被动性的的p 渗出液中出现大量红细胞，则标志着炎症渗出液中出现大量红细胞，则标志着炎症反应剧烈或血管壁损伤严重。反应剧烈或血管壁损伤严重。Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingv炎症的不同阶段，游出的白细胞不同炎症的不同阶段，游出的白细胞不同v致炎因子不同，渗出的白细胞也不同致炎因子不同，渗出的白细胞也不同中中 性性 粒粒 细细 胞胞 急性炎症早期和化脓性炎急性炎症早期和化脓性炎单单核核细细胞胞 急性炎症后期、肉芽肿性炎急性炎症后期、肉芽肿性炎淋淋巴巴细细胞胞 慢性炎症、病毒感染慢性炎症、病毒感染浆浆细细胞胞 慢性炎症慢性炎症嗜嗜酸酸性性粒粒细细胞胞 变态反应、寄生虫感染变态反应、寄生虫感染P63、65Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying关于趋化（自学）v趋化性趋化性/趋化作用？趋化作用？v趋化因子？趋化因子？v趋化因子的作用具有特异性？趋化因子的作用具有特异性？Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingv炎症灶内白细胞吞噬炎症灶内白细胞吞噬病原微生物病原微生物、异物异物 和和组织碎片组织碎片的过程。的过程。v吞噬细胞：吞噬细胞：1.中性粒细胞中性粒细胞(小吞噬细胞小吞噬细胞)2.巨噬细胞巨噬细胞(大吞噬细胞大吞噬细胞)：可融合成多核巨细胞可融合成多核巨细胞（3）吞噬作用）吞噬作用(phagocytosis)Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying1.识别和粘着识别和粘着 2.包围和吞入包围和吞入 3.杀伤和降解杀伤和降解 吞吞噬噬过过程程调理素：特异性抗体和补调理素：特异性抗体和补体，能增强吞噬细胞的识体，能增强吞噬细胞的识别和捕捉作用。别和捕捉作用。吞噬溶酶体吞噬溶酶体Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying再次感染再次感染v有些细菌（如TB）在未激活的白细胞内不易被杀灭，平时处于静止状态，一旦机体抵抗力下降，又能繁殖，并可随吞噬细胞游走而在体内播散。Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingv炎症早期血流动力学改变的顺序为 ()A血流减慢血管扩张，血流加速细动脉短暂收缩白细胞附壁B血管扩张，血流加速细动脉短暂收缩白细胞附壁血流减慢C细动脉短暂收缩血流减慢血管扩张，血流加速白细胞附壁D细动脉短暂收缩血管扩张，血流加速白细胞附壁血流减慢E细动脉短暂收缩血管扩张，血流加速血流减慢白细胞附壁Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingv急性炎症过程中，最先发生哪种变化 ()A白细胞游出B白细胞附壁C吞噬作用D血流淤滞E趋化作用Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingv炎症灶中吸引炎细胞定向集中的现象称为 ()A白细胞游出B白细胞吞噬C白细胞阿米巴运动D趋化性E白细胞渗出Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingv急性炎症48小时后病灶中主要的炎性细胞是（）A淋巴细胞 B嗜碱性粒细胞 C中性粒细胞 D巨噬细胞 E肥大细胞Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingv较多嗜酸性粒细胞浸润见于 ()A伤寒杆菌感染B变态反应或寄生虫感染C乙脑病毒感染D溶血性链球菌感染E葡萄球菌感染Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying下列哪种细胞不是通过变形运动离开血管的（）A中性粒细胞 B红细胞 C嗜酸性粒细胞 D淋巴细胞 E巨噬细胞Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying三、炎症的病理类型三、炎症的病理类型变质性炎变质性炎 以组织细胞的以组织细胞的变性坏死为主变性坏死为主多见于急性炎症：急性乙多见于急性炎症：急性乙型肝炎、乙脑型肝炎、乙脑渗出性炎渗出性炎 以炎症灶内形以炎症灶内形成大量渗出物成大量渗出物为特征为特征多见于急性炎症，又分浆多见于急性炎症，又分浆液性炎、纤维蛋白性炎、液性炎、纤维蛋白性炎、化脓性炎、出血性炎化脓性炎、出血性炎增生性炎增生性炎 以组织细胞的以组织细胞的增生为主增生为主多为慢性炎症（急性：肾多为慢性炎症（急性：肾炎、伤寒）炎、伤寒）按炎症局部组织的基本病变分按炎症局部组织的基本病变分炎症可以分为哪几种？各种炎症的特点是什么？炎症可以分为哪几种？各种炎症的特点是什么？Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying（一）（一）变质变质性炎性炎急性肝炎急性肝炎-肝细胞水肿肝细胞水肿 乙脑乙脑-脑液化性坏死脑液化性坏死 Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying（二）渗出性炎症（二）渗出性炎症类型类型特点特点好发部位及代表性疾病好发部位及代表性疾病浆液性浆液性炎炎以浆液渗出为主以浆液渗出为主炎症较轻，易于消炎症较轻，易于消退退粘膜粘膜-感冒感冒浆膜浆膜-胸膜炎胸膜炎疏松结缔组织疏松结缔组织-二度烫伤二度烫伤纤维蛋纤维蛋白性炎白性炎以渗出物含大量纤以渗出物含大量纤维蛋白为特征维蛋白为特征 粘膜粘膜-假膜性炎：痢疾，白喉假膜性炎：痢疾，白喉浆膜浆膜-绒毛心绒毛心肺肺-大叶性肺炎大叶性肺炎化脓性化脓性炎炎以中性粒细胞渗出以中性粒细胞渗出为主，伴组织坏死、为主，伴组织坏死、脓液形成脓液形成表面化脓和积脓表面化脓和积脓-尿道、胆囊尿道、胆囊脓肿脓肿-皮肤、内脏皮肤、内脏蜂窝织炎蜂窝织炎-肌肉、阑尾肌肉、阑尾出血性出血性炎炎血管损伤严重，渗血管损伤严重，渗出物含大量红细胞出物含大量红细胞流行性出血热、钩体流行性出血热、钩体增生性炎Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying渗出性炎目录渗出性炎目录Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingHE:红染交织的网状、条状或颗粒状，常混有中性粒细胞和坏死组织碎片。（二）纤维蛋白性炎（二）纤维蛋白性炎Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying（1）发发生于粘膜生于粘膜 气管粘膜气管粘膜白喉白喉 大肠粘膜大肠粘膜菌痢菌痢假膜性炎？假膜性炎？Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingv假膜性炎（名词解释）假膜性炎（名词解释）v-发生于发生于粘膜粘膜的的纤维蛋白性炎纤维蛋白性炎，渗出的，渗出的纤维蛋白纤维蛋白、中性粒细胞中性粒细胞、脱落的上皮和坏脱落的上皮和坏死组织死组织等混合在一起，可形成一层膜状物，等混合在一起，可形成一层膜状物，覆盖在粘膜表面，称假膜，因此，粘膜的覆盖在粘膜表面，称假膜，因此，粘膜的纤维蛋白性炎又称为假膜性炎。纤维蛋白性炎又称为假膜性炎。Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingv绒毛心-v 发生于心外膜的发生于心外膜的纤维蛋白性炎，由于纤维蛋白性炎，由于心脏的不断搏动，使心脏的不断搏动，使渗出在心包脏、壁两渗出在心包脏、壁两层表面的纤维蛋白形层表面的纤维蛋白形成无数绒毛状物。成无数绒毛状物。（2）发发生于生于浆浆膜膜Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying镜下：纤维蛋白为红染、网片状或细镜下：纤维蛋白为红染、网片状或细丝状物，夹杂有一定的中性粒细胞。丝状物，夹杂有一定的中性粒细胞。Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingv大叶性肺炎：以纤维蛋白为主的渗出物充满了肺泡腔肺质地变实（肝样变）（3）发发生于肺生于肺渗出性炎目录渗出性炎目录Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying（三）化（三）化脓性炎性炎(purulent inflammation)v定义：定义：大量中性粒细胞渗出，伴不同程度的大量中性粒细胞渗出，伴不同程度的 组织坏死和脓液形成。组织坏死和脓液形成。v病因：病因：葡萄球菌（疖、痈）葡萄球菌（疖、痈）链球菌（化脓性阑尾炎）链球菌（化脓性阑尾炎）脑膜炎双球菌（化脓性脑膜炎）脑膜炎双球菌（化脓性脑膜炎）大肠杆菌（肾盂肾炎）大肠杆菌（肾盂肾炎）v化脓？化脓？v脓液？脓液？v脓细胞脓细胞?Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying类型型脓肿多发生于皮肤和内脏局限性局限性,与周围组织分界清楚蜂窝织炎疏松结缔组织：皮下、肌肉间、阑尾弥漫性弥漫性,与周围组织分界不清表面化脓和积脓粘膜浆膜，囊、腔、管表浅表浅，不累及深部组织Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying脓肿(abscess)v定义组织内局限性局限性化脓性炎症。v主要特征组织发生溶解坏死，形成充满脓液的腔。v好发部位皮肤、内脏器官皮肤、内脏器官v病因、发病机制金葡菌金葡菌 毒素+N（蛋白溶解酶）组织坏死液化（形成脓肿）血浆凝固酶使纤维蛋白原纤维蛋白（局限病灶）Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying疖疖是毛囊、皮脂腺及其附近组织所发生的脓肿。疖是毛囊、皮脂腺及其附近组织所发生的脓肿。Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying痈痈是多个疖的融合，在皮下脂肪筋膜痈是多个疖的融合，在皮下脂肪筋膜组织形成多个互相沟通的脓肿。组织形成多个互相沟通的脓肿。Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying蜂蜂窝织炎炎(phlegmonous inflammation)v定义定义疏松结缔组织的疏松结缔组织的弥漫性弥漫性化脓性炎化脓性炎v好发部位好发部位皮下、肌肉间、阑尾皮下、肌肉间、阑尾v病变特点病变特点大量中性粒细胞弥漫浸润，无脓腔形成，与大量中性粒细胞弥漫浸润，无脓腔形成，与正常组织正常组织分界不清分界不清，炎症灶中原有组织坏死可不明显。，炎症灶中原有组织坏死可不明显。v病因、发病机制病因、发病机制溶血性链球菌溶血性链球菌 透明质酸酶透明质酸酶溶解透明质酸，细菌易扩散；溶解透明质酸，细菌易扩散；链激酶链激酶溶解纤维蛋白（溶解纤维蛋白（炎症弥漫）炎症弥漫）Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying化脓性尿道炎（淋病）化脓性尿道炎（淋病）（3 3）表面化脓和积脓）表面化脓和积脓渗出性炎目录渗出性炎目录Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying（四）出血性炎（四）出血性炎v血管损伤严重，渗出物血管损伤严重，渗出物中含大量中含大量红细胞红细胞v常与其他炎症同时存在常与其他炎症同时存在v举例举例大叶性肺炎红大叶性肺炎红色肝样变期色肝样变期（纤维蛋白性出血性炎）（纤维蛋白性出血性炎）渗出性炎目录渗出性炎目录Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingv患者，女性，患者，女性，30岁，左手不慎被沸水烫岁，左手不慎被沸水烫伤，局部立即出现红、肿、热、痛，随伤，局部立即出现红、肿、热、痛，随之皮肤上起水泡，其病变属（之皮肤上起水泡，其病变属（）A 变质性炎变质性炎 B 浆液性炎浆液性炎 C纤维素性炎纤维素性炎 D化脓性炎化脓性炎 E出血性炎出血性炎Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingv溶血性链球菌感染最常引起 ()A蜂窝织炎B脓肿C纤维素性炎D假膜性炎E出血性炎Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingv患者，男，45岁。因高热、咳嗽、咳大量脓痰入院。X线示一有液平面的空腔。手术切除病变肺组织，巨检见病变中央呈囊腔状，腔内含黄色脓液，镜下腔壁可见大量变性坏死中性粒细胞，可诊断为 ()A肺结核B肺脓肿C小叶性肺炎D大叶性肺炎E肺癌Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingv急性细菌性痢疾的典型肠道病变是（）A假膜性炎 B蜂窝织炎 C出血性炎 D化脓性炎 E卡化性炎Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying五、炎症的临床分型和结局五、炎症的临床分型和结局（一）临床分型（一）临床分型病程病程临床表现临床表现病理变化病理变化超急性炎症超急性炎症 几小时几小时-几几天天暴发性经过，暴发性经过，反应剧烈反应剧烈组织器官严重损害，组织器官严重损害，多属变态反应性炎多属变态反应性炎急性炎症急性炎症几天几天-1个个月月起病急，症状起病急，症状明显明显以变质渗出为主，中以变质渗出为主，中性粒细胞浸润性粒细胞浸润亚急性炎症亚急性炎症 1个月个月-几几个月个月少见，常由急少见，常由急性转变而来性转变而来/慢性炎症慢性炎症几个月几个月-几几年年起病缓慢，临起病缓慢，临床表现不明显床表现不明显以增生为主，慢性炎以增生为主，慢性炎细胞浸润细胞浸润Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying（三）增生性炎（三）增生性炎v以组织细胞的增生为主的炎症v多为慢性炎症（2个例外？）v分类：1.非特异性增生性炎非特异性增生性炎2.特异性增生性炎特异性增生性炎-肉芽肿性炎肉芽肿性炎Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying1、非特异性增生性炎、非特异性增生性炎特点：特点：v慢性炎细胞浸润：巨噬细胞、淋巴细胞、浆细胞v血管内皮细胞、成纤维细胞、上皮细胞等增生。特殊形态：特殊形态：v炎性息肉炎性息肉v炎性假瘤炎性假瘤Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying炎性息肉炎性息肉Inflammatory polypDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying2、肉芽肿性炎、肉芽肿性炎v概念：概念：炎症局部以巨噬细胞及其演变的细胞增炎症局部以巨噬细胞及其演变的细胞增生为主，形成境界清楚的结节状病灶。生为主，形成境界清楚的结节状病灶。v病理学上常能根据肉芽肿的物殊形态来帮助确病理学上常能根据肉芽肿的物殊形态来帮助确定炎症的原因。定炎症的原因。类型病因/特殊形态感染性肉芽感染性肉芽肿肿结核结核-结核结节：上皮样细胞、朗汉斯巨细胞结核结节：上皮样细胞、朗汉斯巨细胞伤寒伤寒-伤寒小结：伤寒细胞伤寒小结：伤寒细胞风湿风湿-风湿小体：风湿细胞风湿小体：风湿细胞异物肉芽肿异物肉芽肿 硅尘、外科缝线硅尘、外科缝线-异物巨细胞异物巨细胞Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying肺粟粒性结核肺粟粒性结核-结核性肉芽肿结核性肉芽肿Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying五、炎症的局部表现和全身反应五、炎症的局部表现和全身反应一一.局部表现：红、肿、热、痛，功能障碍局部表现：红、肿、热、痛，功能障碍 甲沟炎甲沟炎急性扁桃体炎急性扁桃体炎炎症有何临床表现？为什么会有这些临床表现？炎症有何临床表现？为什么会有这些临床表现？Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying二二.全身表现：全身表现：v发热发热v白细胞变化白细胞变化v单核巨噬细胞系统增生单核巨噬细胞系统增生v实质器官病变实质器官病变Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying五、炎症的临床分型和结局五、炎症的临床分型和结局（一）临床分型（一）临床分型病程病程临床表现临床表现病理变化病理变化超急性炎症超急性炎症 几小时几小时-几几天天暴发性经过，暴发性经过，反应剧烈反应剧烈组织器官严重损害，组织器官严重损害，多属变态反应性炎多属变态反应性炎急性炎症急性炎症几天几天-1个个月月起病急，症状起病急，症状明显明显以变质渗出为主，中以变质渗出为主，中性粒细胞浸润性粒细胞浸润亚急性炎症亚急性炎症 1个月个月-几几个月个月少见，常由急少见，常由急性转变而来性转变而来/慢性炎症慢性炎症几个月几个月-几几年年起病缓慢，临起病缓慢，临床表现不明显床表现不明显以增生为主，慢性炎以增生为主，慢性炎细胞浸润细胞浸润Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying（二）炎症的结局（二）炎症的结局1.痊愈痊愈2.迁延不愈转为慢性迁延不愈转为慢性3.蔓延扩散蔓延扩散p局部蔓延局部蔓延p淋巴道扩散淋巴道扩散p血道扩散血道扩散炎症的结局如何？炎症的结局如何？Department of Pathology，Shaoxing University Medical College，Zhang Qiao-yingDepartment of Pathology，ShaoxDepartment of Pathology，Shaoxing University Medical College，Zhang Qiao-ying血道血道扩散散(1)菌血症菌血症(bacteremia)血液中有细菌，但无明显症状。血液中有细菌，但无明显症状。(2)毒血症毒血症(toxemia)毒素及代谢产物吸收入血，毒素及代谢产物吸收入血，产生全身中毒症状，血培养阴性。产生全身中毒症状，血培养阴性。(3)败血症败血症(septicemia)血中大量繁殖，产生毒素，引起寒战、血中大量繁殖，产生毒