第1章细胞组织损伤和适应

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,第一章 细胞、组织的适应和损伤Adaptation and Injury of Cell and Tissue,第一节 细胞与组织的适应 Adaptation of Cell and Tissue,1、萎缩,2、肥大,3、增生,4、化生,一、萎缩Atrophy,（一）概念,已发育成熟的细胞、组织或器官的体积缩小，伴功能降低。,A decrease in the size and number of cells is commonly referred to clinically as atrophy.,（二）分类,1 生理性,2 病理性,（1）营养不良性,（2）压迫性,（3）废用性,（4）神经性,（5）内分泌性,（三）病理变化,光镜,：萎缩的细胞、组织体积缩小，细胞器退化，可出现脂褐素颗粒。,肉眼,：萎缩的器官体积缩小，重量减轻，色深。,心-心尖变尖，被膜皱缩，被膜下血管,呈蛇形状弯曲。,脑-脑回变窄，脑沟变深。,注意：间质不萎缩，反而可增生。,肝细胞压迫性萎缩,Atrophy of liver,右侧为肿瘤，中间为受肿瘤压迫萎缩的肝细胞。,肾压迫性萎缩,Atrophy of Kidney,脑压迫性萎缩,Atrophy of brain,正,常,心,脏,萎缩心(表面）,Atrophy of heart,心包膜下血管呈蛇形弯曲,萎缩心（切面）,心脏体积缩小，心尖变尖。,二、肥大Hypertrophy,（一）概念,细胞、组织或器官体积增大的现象。,Definition: An increase in the size and number of cells is commonly referred to clinically as hypertrophy.,（二）分类,1生理性,2 病理性,（1）代偿性,（2）内分泌性,心肌肥大Hypertrophy of heart,心肌肥大,Hypertrophy of heart,*,心肌细胞肥大,Hypertrophy of heart,三、增生Hyperplasia,一、概念,组织或器官内的实质细胞数量增多的现象。,Definition: Organ growth can also be the result of an increase in the number of cells, a process called “hyperplasia”.,二、分类,1、 生理性,2、病理性,（1）再生性,（2）炎症性,（3）肿瘤性,甲状腺结节状增生 Hyperplasia of thyroid,*,甲状腺滤泡增生 Hyperplasia of thyroid,乳腺增生,Hyperplasia of mammary,前列腺增生 Hyperplasia of prostate gland,子宫内膜增生,Hyperplasia of uterus endometrium,四、化生Metaplasia,（一）概念,一种分化成熟的细胞、组织转变成另一种分化成熟的细胞、组织的过程。,Definition: Metaplasia is usually defined as the transformation of fully differentiated cells of one kind into differentiated cell of another kind in response to abnormal stimuli.,（二）分类,1、鳞状上皮化生,2、肠上皮化生,3、骨或软骨化生,Metaplasia in epithelium of bronchial epithelium,Metaplasia in colon epithelium of gastric glandular epithelium,（三）意义,1、局部的结构增强，功能减弱。,2、可能发生细胞恶变。,第二节细胞、组织的损伤 Injury of cell and tissue,一、损伤的原因与发生机制,1、细胞膜的破坏,2、活性氧类物质的损伤,3、细胞膜内高游离钙的损伤,4、缺氧的损伤,5、化学性损伤,6、遗传变异,二、形态变化,（一）可逆性损伤-变性,1、细胞水肿 Cellular swelling,2、脂肪变性,Fatty degeneration / Steatosis,3、玻璃样变 Hyaline degeneration,4、病理性钙化 Pathologic calcification,1、细胞水肿,cellular swelling,（1）概念,细胞受损时，细胞膜上Na+K+ATP酶功能障碍，致细胞内Na+、水蓄积。严重者，发生水变性。,The fluid in the cell is increased after injury, because of the dysfunction of Na-K-ATPase.,（2）病变,部位：心、肝、肾,肉眼：受累器官体积增大，包膜紧张，灰白色。,光镜：细胞体积增大，胞浆内充满红染颗粒状物。,*,肾小管上皮细胞水肿,Cellular swelling of tubercular epithelium,肾小管上皮细胞水肿Cellular swelling of tubercular epithelium,肾小管上皮细胞水肿（电镜,X5000,）,肝细胞水肿 Cellular swelling of liver,肝细胞水肿,Cellular swelling of hepatocytes,*,心肌细胞水肿,Cellular swelling of heart cell muscles,2、脂肪变性,Fatty degeneration/Steatosis,（1）概念,除脂肪细胞外的其它实质细胞胞浆内出现脂滴。,Lipid droplets appear in the cells except fatty cells.,（2）病变,部位：心、肝、肾实质细胞。,肉眼：受累脏器体积增大，包,膜紧张，色淡黄，有油,腻感。,光镜：胞体增大，胞浆中出现,大小不等的空泡。,肝脂肪变性,Fatty degeneration of liver,心肌脂肪变性 Fatty degeneration of heart,（ 3 ）原因：,缺氧、中毒、营养不良、高脂饮食等。,（4）机制：以肝细胞脂肪变性为例：,1、肝细胞内脂肪酸增多；,2、甘油三酯合成过多；,3、脂蛋白、载脂蛋白减少；,3、玻璃样变,Hyaline degeneration,（1）概念：,细胞内或间质中出现HE染色为均质嗜伊红半透明状的蛋白质蓄积,。,There are a group of alteration that represent to collectively as hyaline change become of their homogeneous glasslike appearance by light microscopy.,（2）病变,部位：细胞或间质。,表现：,细胞,：肾小管上皮细胞,-玻璃样小体。,肝细胞-Mallory小体。,肾近曲小管上皮胞浆内玻璃样小滴变性,Hyaline of the proximal tubules of kidney,间质,：,(1)纤维结缔组织-瘢痕组织、萎缩的子宫和乳腺间质、动脉粥样硬化斑块；,(2)血管（细动脉壁）-高血压、糖尿病。,纤维结缔组织玻璃样变（疤痕）,Hyaline in connective tissues,Hyaline of the walls arterioles,4、病理性钙化,Pathologic calcification,（1）概念：,骨、齿以外的组织中有固态钙盐沉积。,Definition: abnormal deposits of calcium in injured and dead tissue is a common finding in human pathologic condition.,（2）分类：,-营养不良性钙化：钙盐沉积于坏死或即将坏死组织或异物中，体内钙磷代谢正常。,-转移性钙化：钙盐沉积于正常组织内，体内钙磷代谢不正常。,冠状动脉粥样硬化继发营养不良性钙化,寄生虫卵钙化,（二）不可逆性损伤- 坏死 Necrosis,1、概念：,活体内局部组织细胞的死亡，同时伴有炎症反应。,图,1-,33,When focal death and autolysis of cells and a tissue occur in a living body, the process is referred to as necrosis; since the focus rapidly incites activation of body cellular defense, it is rapidly surrounded by an inflammatory reaction.,2、坏死的基本病变：,（1）核固缩 pyknosis,（2）核碎裂 karyorrhexis,（3）核溶解 karyolysis,肝细胞核固缩、碎裂、溶解,细胞坏死的早期电镜形态,3、坏死的类型,（1）凝固性坏死,特点：蛋白质凝固、坏死干,燥、质实。,部位：心、肝、肾、脾。,临床：梗死。,特殊：干酪样坏死-结核病。,脾凝固性坏死 coagulative necrosis of spleen,肾凝固性坏死,coagulative necrosis of kidney,肠系膜 淋巴结干酪样坏死,caseous necrosis of lymph node,淋巴结干酪样坏死,caseous necrosis of lymph node,（2）液化性坏死,特点：水解酶分解蛋白质使组织细胞发生溶解液化。,部位：脑、胰。,临床：脑软化、脓肿、阿米巴病。,脂肪坏死-乳腺创伤。,脑液化性坏死,liquefactive necrosis of brain,肝液化性坏死,liquefactive necrosis of liver,脂肪坏死 fat necrosis,（3）坏疽：,特点：大面积组织坏死，继发腐败菌感染。,类型：,干性,湿性,气性,干性坏疽 dry gangrene,部位：体表、四肢末端。,特点：坏死区干燥皱缩，呈黑色（Fe,2+,+H,2,S,FeS+H,2,），与正常组织分界清楚。全身中毒症状不明显。,临床：血栓闭塞性脉管炎。,足干性坏疽,dry gangrene of foot,湿性坏疽 moist gangrene,部位：与外界相通的器官：肺、子宫、阑尾、胆囊。,特点：坏死区水分较多，腐败菌大量繁殖而肿胀、呈暗绿色，与正常组织分界不清。全身中毒症状重。,临床：肺坏疽、肠坏疽、坏疽性子宫内膜炎。,肠湿性坏疽,moist gangrene of colon,气性坏疽 gas gangrene,部位：深部组织的开放性创伤。,特点：创伤合并大量产气腐败菌感染，使局部肿胀、有捻发音，全身中毒症状重。,临床：战伤。,（4）纤维素样坏死Fibronoid necrosis（1）特点：坏死呈细丝状、颗粒状或小条块状无结构物。（2）临床：风湿病、高血压病、新月体性肾小球肾炎。,*,肾小球纤维素样坏死(HEX200),4、坏死的结局：,（1）溶解吸收,（2）分离排出,（3）机化与包裹,（4）钙化,第三节 细胞凋亡 Apoptosis,1、概念： 体内外某些因素触发细胞内预存的死亡程序，导致细胞主动性死亡的方式，不伴炎症反应，在形态和生化特征上都有别于坏死。,Definition: Apoptosis is referred to the death of a cell or a group of cells without destroyed cellular membrane and inflammatory reaction. It is also termed programmed cell death (PCD) because it relates to gene regulation.,2、生化特征：,在细胞内核酸内切酶作用下，DNA降解，形成寡核苷酸片段。,3、形态特征：,凋亡的细胞体积缩小，圆形，胞质致密；凋亡小体形成。,细胞凋亡小体 apoptosis body,4、意义：,（1）生理上：,胚胎发生、成熟细胞的新,陈代谢、生理性退化。,（2）病理上：,肿瘤、自身免疫性疾病等。,5、发生机制：,死亡基因的启动，即程序性死亡。,6、与坏死的比较：,Necrosis Apoptosis,_,Stimulitoxins hypoxia, insult physiological, pathological,ATP depletion without ATP depletion,Patterns Groups of neighboring cells Single cells,Histologic Cell swells; Cell contracts;,organelles swell; disruption chromatin condenses,of organelles occurs apoptotic bodies form,membrane lysed membrane intact,DNA Diffuse and random Internecleosomal cleavage,Mechanism No DNA, protein New protein synthesis,Tissue reaction Inflammation No,