炎症医学知识培训培训课件.ppt

1、炎症医学知识培训炎症医学知识培训 Section I Introductory Remark I.The Concept of Inflammation The Definition and Significance of Inflammation:Inflammation 炎症炎症 Inflammation is the local defensive responses局部防御反局部防御反应应 to injury factors by living organisms possess of vascular system拥有血管系统拥有血管系统.炎症医学知识培训2 At first,we

2、should bring out the general idea of the inflammation.1.It is forming step by step to fight against injury during the course of evolution of organism.生物进生物进化中产生化中产生 Unicellular organism Non-vascular system Pinocytosis multicellular organism (e.g.parasite,invertebrate 无脊椎动物无脊椎动物)The organism possess

3、of vascular system Vasoresponse is cardinal feature of defense response Contain of pinocytosis 炎症医学知识培训32.Vascular events play the central role of inflammatory response血管反应为中心血管反应为中心3.It is a more stereotyped nonspecific biological defensive mechanism against any of the environmental invaders反应是反应是

4、定型的定型的.4.These are the 3 major pathological change of inflammation,namely,Alteration,Exudation,&Proliferation变质、渗出、增生变质、渗出、增生5.It is not,in itself,a disease,but is usually a manifestation of disease,and usually accompanied with fever and leukocytosis 是临床表现，如发热、白细胞增多是临床表现，如发热、白细胞增多炎症医学知识培训4 6.In stud

5、ying the process of inflammation,we shouldnt ignore either of these 2 side for they are unified in one coin.有益有害两方面有益有害两方面 On the one hand:Inflammation may have beneficial effects,such as the destruction of invading micro-organisms and walling-off of an abscess cavity,thus preventing spread of infec

6、tion.On the other hand:Inflammation may also have harmful effects,for example:炎症医学知识培训5 An abscess in the brain would act as a space-occupying lesion compressing vital surrounding structures.Fibrosis resulting from chronic inflammation may distort the tissue and permanently alter their function (e.g

7、.liver cirrhosis).In children the swelling of the epiglottis in acute epiglottitis may obstruct the airway.炎症医学知识培训6 I I.The causes of inflammation 炎症原因炎症原因 Causes of cellular damage are still causes of inflammation.The principal causes of inflammation included biological agents,physical agents,chem

8、ical agents,immunological reactions and genetic agents etc.The biological agents are most important and common causes of inflammation.(e.g.bacteria,virus,rickettside,fungi,and parasite etc.)Infection感染感染 It is a kind of inflammation due to biological pathogen.炎症医学知识培训7physical agents,包括高温、低温、外伤、放射线包

9、括高温、低温、外伤、放射线 chemical agents,强酸、强硷，某些毒性化学强酸、强硷，某些毒性化学物质以及体内产生的化学物质（如坏死组物质以及体内产生的化学物质（如坏死组织的崩解产物，胆囊穿孔，胆汁流入腹腔、织的崩解产物，胆囊穿孔，胆汁流入腹腔、消化液的外溢等）。消化液的外溢等）。immunological reactions 如各型变态反应如各型变态反应genetic agents如如抗胰蛋白酶缺陷抗胰蛋白酶缺陷 炎症医学知识培训8 III.The essential change of inflammation degeneration Alteration necrosis f

10、luid exude Exudation leukocyte exude monocyte-macrophage Proliferation endotheliocyte,fibroblast parenchyma (e.g.cover epithelium,glandular epithelium)炎症医学知识培训9IV.The Manifestation,Systemic Response of Inflammation (I).Local appearance Redness 红红 An acutely inflamed tissue appears red for example sk

11、in affected by sunburn.This is due to dilatation of small blood vessels within the damaged area.Swelling 肿肿 Swelling result from edema.Heat 热热 Increase in temperature is seen only in peripheral parts of the body,such as the skin.It is due to increased blood flow (hyperaemia)through the region.炎症医学知识

12、培训10 Pain 痛痛 It results partly from the stretching and distortion of tissue due to inflammatory edema and,in particular,from pus under pressure in an abscess cavity.Some of the chemical mediators of acute inflammation,such as prostaglandins前列腺素前列腺素,are known to induce pain.Loss of function 功能障碍功能障碍

13、Movement of an inflamed area is consciously and reflexly inhibited by pain,while severe swelling may physically immobilise the tissue.炎症医学知识培训11(II)Systemic response Fever Systemic fever,which results from:Exogenous pyrogen:e.g.bacterial toxins,some kind of virus,IC,etc.Endogenous pyrogen:e.g.cellul

14、ar factor (IL-1,TNF)Prostagladin(PG)炎症医学知识培训12 Leukocytosis For the patient,it is one of the known features of acute inflammtion.Normal:4-10 109/L 类白细胞反应类白细胞反应 shift to the left核左移核左移:indicative of severe infection 炎症医学知识培训13 The kind of leukocyte of peripheral blood 外周外周血血 is in relation to infecti

15、ve pathogen.Acute suppurative inflammation and early stages of acute inflammation increase of neutrophilic granulocyte Late stages of acute inflammation increase of monocyte-macrophage Chronic inflammation and virus infection increase of lymphocyte and monocyte The infection of parasite and allergos

16、es increase of eosinophilic leukocyte 炎症医学知识培训14 resistance is low,Leukopenia indicative of severe infection some kind of infection (e.g.typhoid fever伤寒伤寒,virus infection)炎症医学知识培训15 The clinical types of inflammation 炎症的临床类型 The clinical types of inflammationare classified according to course ofdise

17、ase as:1.Peracute inflammation:the course persistence of some hours or a few days.It is allergoses commonly.e.g.anaphylaxis过敏过敏 due to penicillin;acute transplant rejection 炎症医学知识培训162.Acute inflammation:the course persistence of several days,dont exceed a month commonly.the pathological changes are

18、 major of alteration 变质变质and exudation渗出渗出,and increase of neutrophilic granulocyte中性中性 白细胞白细胞.3.Chronic inflammation:the course may be prolonged for several months or several years.the pathological change are major of proliferation增生增生,and increase of lymphocyte,plasmocyte and monocyte淋巴细胞、浆细胞、单核细胞

19、淋巴细胞、浆细胞、单核细胞.4.Subacute inflammation:It is intermediate between that of acute inflammation and that of chronic inflammation.e.g.subacute severe heptitis subacute infective endocarditis 炎症医学知识培训17 Section II Acute Inflammation Acute inflammation is an immediate and direct defensive response to injur

20、y factors by living organisms in its early stage.Vascular response playing the central role of changes are major of exudation.It include fluid(antibody)and leukocyte(neutrophilic granulocyte)病程短、起病急病程短、起病急 病变以变质和渗出为主病变以变质和渗出为主 炎症细胞以中性白细胞为主炎症细胞以中性白细胞为主炎症医学知识培训18 Exudation Exudation渗出渗出Edema fluid,fib

21、rin and neutrophil polymorphs accumulate in the extracellular spaces of the damaged tissue.Exudation of edema fluid and leukocyte is known as exudate渗出物渗出物.Exudate,especially neutrophil polymorph,is essential for a histological diagnosis of acute inflammation.Major courses of exudation are changes i

22、n hemodynamics,increased vascular permeability血管通透性血管通透性,fluid exudate and cellular exudate.炎症医学知识培训19I.Changes in hemodynamics 1.Microarteriospasm痉挛痉挛:transient vasoconstriction (the courses persistence of a few second)2.Vasodilatation and acceleration of blood flow:(inflammatory hyperemia)3.Blood

23、flow begins to slow 4.(at least,occur stasis)炎症医学知识培训20II.Increased vascular permeability 1.Constriction of endothelial cell2.Transcytosis3.Endothelial injury 4.High permeability of newly formed capillary wall炎症医学知识培训21 Fluid exudate Exudation of fluid rich protein is called exudate渗出液渗出液.Inflammato

24、ry edema炎性水肿：炎性水肿：exudate accumulate in the extracellular space.Inflammatory hydrops积液：积液：exudate accumulate in the serosal cavity.炎症医学知识培训22水肿发生简要机制：水肿发生简要机制：体内外液体交换失衡：球管失衡体内外液体交换失衡：球管失衡 血管内外液体交换失衡血管内外液体交换失衡毛细血管流体静压毛细血管流体静压血浆胶体渗透压血浆胶体渗透压血管通透性血管通透性淋巴回流淋巴回流炎症医学知识培训23Table 4-1 comparison of exudate an

25、d transudate transudate exudate vasopermeability nomal increase Contain of protein 0-1.5g/dl 0-1.5g/dl Kinds of protein Major of albumin Various of protein Rivalta text negative positive fibrin without possess Specific gravity 1.020 The number of cells 0.5109/L 炎症医学知识培训24 Beneficial effects of exuda

26、te:a.Dilution of toxins 稀释毒素稀释毒素,such as produced by bacteria,allows them to be carried away in lymphatics.b.Neutralization of toxins中和毒素中和毒素 entry of antibodies,they may lead either to lysis of micro-organisms,through the participation of complement,or to their phagocytosis by opsonization.C.Fibrin

27、 formation 纤维素纤维素 it from exuded fibrinogen may impede the movement of microorganisms,trapping them and so facilitating phagocytosis吞噬作用吞噬作用.炎症医学知识培训25 Surface phagocytosis表面吞噬作用表面吞噬作用 It is thought that phagocytosis may be facilitated if the bacterium can be trapped or cornered against a surface,su

28、ch as strands of fibrin,or in the interstices between two or more cells.炎症医学知识培训26 Harmful effects of exudate:Edema of tissues may increase in severity of local disturbance of circulation.Severe swelling of the epiglottis in acute epiglottitis may obstruct the airway.Excessive hydrops may have a bed

29、 effect on organ function.(e.g.hydropericardium心包积水心包积水,hydrothorax胸胸腔积水腔积水)Organization of fibrin may lead to pulmonary carnification肺肉质变肺肉质变 and adhesion 粘连粘连 (e.g.adhesive peritonitis腹膜炎腹膜炎,adhesive pericarditis心包炎心包炎,adhesive pleurisy胸膜炎胸膜炎).炎症医学知识培训27III.Cellular exudate and its effects Inflamm

30、atory cell infiltration 炎症细胞浸润炎症细胞浸润:The accumulation of leukocytes within the extravascular space.It is the most important aspect of the inflammatory process.炎症医学知识培训28 Leukocytes transmigration It include major of three steps by:1.Margination and pavementing of leukocytes 2.Adhesion 3.Transmigrati

31、on 炎症医学知识培训29 Red cell diapedesis 红细胞漏出红细胞漏出 It is negative process of red cell diapedesis.The sigh of red cell occured in extravascular spaces are suggestive of severe injury.炎症医学知识培训30 3.Leukocytes transmigration of injured area and chemotaxis Chemotaxis趋化作用趋化作用 Unidirectional migration of WBC to

32、the site of injury is mediated by diffusible chemical attractants This chemical attractant is called chemotactic agents趋化因子趋化因子.炎症医学知识培训31 2 main sources of chemotactic agents:Exogenous bacterial products Endogenous derived from plasma proteins (complements,C5a)or leukotrene B4 and chemokine (IL-8,M

33、CP,lymphotactin巨噬细胞、巨噬细胞、淋巴细胞趋化蛋白淋巴细胞趋化蛋白).炎症医学知识培训32 4.The effects of leukocytes (1).Phagocytosis吞噬杀灭作用吞噬杀灭作用 Phagocytosis by leukocytes involves recognition 识别识别,engulfment吞入吞入,killing杀灭杀灭,and degradation消化消化 of ngested material.Leukocyte possession of phagocytosis may be called phagocyte.炎症医学知识培训

34、331).kinds,structures and function of phagocytes i.neutrophils(microphages)Around 60%of the total number of peripheral leukocytes LM:laboid nucleus,Neitrophilic granules (azurophilic granules,specific granules)EM:lysosoma 炎症医学知识培训34 ii.Macrophage Monocyte Macrophage Histocyte (Kupffers cell,sinusoid

35、 histocyte,dust cell,and microgliocyte,etc.)炎症医学知识培训35iii.Eosinophilic leukocyte It is a little larger than neutrophil rod nucleus or laboid nucleus,eosinophilic granules Its phagocytosis is weak and phagocytosis of IC.炎症医学知识培训36 Kinds and structures of phagocytes炎症医学知识培训37 The kinds of leukocytes o

36、f infiltration are in relation to stages of inflammation.The early stages of major of acute inflammation increase of neutrophilic granulocyte (6-24h)Late stages of acute inflammation increase of monocyte-macrophage (24-48h)炎症医学知识培训38 The kinds of leukocytes of peripheral blood are also in relation t

37、o infective inflammatory factors.Acute suppurative inflammation急性急性 化脓性炎、一般细菌感染化脓性炎、一般细菌感染 increase of neutrophilic granulocyte 特殊细菌感染。如结核，特殊细菌感染。如结核，increase of monocyte Virus infection 病毒感染病毒感染 increase of lymphocyte and monocyte The infection of parasite and allergoses 寄生虫和变态反应寄生虫和变态反应 increase o

38、f eosinophilic leukocyte炎症医学知识培训392).Phagocytic course i.Recognition and attachment (opsonization)(the receotor of Fc and C3b)调理素，调理素，调理素化作用调理素化作用 ii.Engulfment,forming phagosome,further forming phagolysosome (degranulation)iii.killing or degradation 炎症医学知识培训40 There are 2 major categories of bacter

39、icidal mechanisms:a).Oxygen-dependent mechanisms leukocytic oxidase is activated (NADPH oxidase还原型辅酶还原型辅酶)H2O2 (MPO髓过氧化物酶髓过氧化物酶)HOCl.次氯酸次氯酸 b).Oxygen-independent mechanisms Lysosomal enzymes溶酶体酶溶酶体酶;lysozyme;arginine-rich cationic proteins (phagocytins)Bactericidal permeability increasing protein,BP

40、I 细菌通透性增高蛋白细菌通透性增高蛋白炎症医学知识培训41(2).Immune effects免疫作用免疫作用 Macrophages phagocytose antigen and send message of antigen to T-cells and B-cells T-cells release the lymphokine (cellular immunity)B-cells produce the immunoglobulin (humoral immunity)NK-cell(natural killer cell)分泌作用：白细胞介素、干扰素、肿瘤坏死因子分泌作用：白细胞

41、介素、干扰素、肿瘤坏死因子(3).Effects of tissue injury 组织损伤组织损伤 （消极作用，副反应）（消极作用，副反应）炎症医学知识培训42IV.Inflammatory Mediator Inflammatory mediator 炎症介质炎症介质 A lot of acute inflammatory response due to endogenous chemical mediators.These chemicals,called inflammatory mediator.炎症医学知识培训43 The general feature of inflammato

42、ry mediator1.Inflammatory mediators are from cells and plasma.The former is stored in the cell by granules in form;The latter is present in plasma by precursor in form.细胞以颗粒形式释放，血浆中以前体激活形式激活细胞以颗粒形式释放，血浆中以前体激活形式激活2.The relation of inflammatory mediator and target cell (i.specific特异性特异性;ii.secondary r

43、esponse二级二级 反应反应;iii.Nonspecific非特异性非特异性)3.A lot of inflammatory mediators are possessed of potential danger of tissue有潜在的危害有潜在的危害.炎症医学知识培训44 Major of inflammatory mediator and its effects(I)Inflammatory mediators are released from cells 1.Vascular amines血管活性胺血管活性胺:include of histamine组织胺组织胺 and 5-h

44、ydrooxytryptamine5-羟色胺羟色胺 炎症医学知识培训45 1).Histamine:It is stored in mast cells主细胞主细胞,basophil嗜碱性嗜碱性白细胞白细胞 and platelets血小板血小板.Histamine release from these sites(for example,mast cell degranulation)is stimulated by complement components补体补体 C3a and C5a,and by lysosomal proteins溶酶体酶溶酶体酶 released from ne

45、utrophils.It causes vascular dilatation and immediate transient phase of increased vascular permeability血管扩张，通透性增高血管扩张，通透性增高.炎症医学知识培训46 2).5-hydrooxytryptamine,5-HT:5-羟色胺羟色胺 This is present in high concertration in mast cells and plateles.It also increase vascular permeability.炎症医学知识培训47 2.Metabolit

46、e of arachidonic acid,AA phospholipase phospholipid of membrane AA It include prostagladin 前列腺素前列腺素(PG),leukotrene 白细胞三烯白细胞三烯(LT),and lipoxins脂毒素脂毒素.前列腺素：前列腺素：合成：组织损伤合成：组织损伤溶酶体酶中的磷脂酶释放溶酶体酶中的磷脂酶释放细胞膜磷脂细胞膜磷脂20碳碳脂肪酸脂肪酸前列腺素合成酶前列腺素合成酶前列腺素前列腺素 炎症医学知识培训48 Prostagladin,PG These are a group of long-chain fat

47、ty acids derived from arachidonic acid and synthesised by many cell types.It causes vascular dilatation血管扩张血管扩张 and increases in vascular permeability通透性增高通透性增高 It may causes fever发热发热 and pain疼痛疼痛.炎症医学知识培训49 3.product of leukocyte and lysosomal compounds activitic products of oxygen metabolism(O2.-

48、,H2O2,OH.)lysosomal compounds溶酶体成分溶酶体成分 炎症医学知识培训50 4.Cytokine and chemokine 细胞因子和趋化性细胞因子细胞因子和趋化性细胞因子 The former,a family of chemical messengers released by lymphocytes and monocytes.(lymphokine,monokine).The letter include IL-8,MCP and lymphotactin.炎症医学知识培训51 (II)Plasma factors:Plasma factors includ

49、e complement system,kinin system and clotting system.三个系统：三个系统：补体系统补体系统:C3a、C5a趋化因子、趋化因子、C3b调理素调理素 激肽系统：如缓激肽激肽系统：如缓激肽 凝血系统：纤维素渗出，限制细菌播散、凝血系统：纤维素渗出，限制细菌播散、利于中性白细胞捕捉细菌利于中性白细胞捕捉细菌 炎症医学知识培训52Kinin system:Bradykinin缓激肽缓激肽 is the most important vascular permeability factor Bradykinin is also a chemical me

50、diator of the pain which is cardinal feature of acute inflammation.The kinin system is activated by coagulation factor XII Products of the kinin,coagulation and fibrinolytic system can activate complement.炎症医学知识培训53V.Common Histologic Patterns of Acute Inflammation Alterative inflammation变质性炎变质性炎 Ma