荟萃10临本损伤的修复课件.ppt

1、Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time 第二章损伤的修复卫生部教材病理学（本科第七版）2012.03.Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time 教学目标?掌握：再生的概念、各种组织的再生潜能肉芽组织的概念、形态特点及其作用瘢痕组织的概念创伤愈合的

2、基本过程?熟悉：各种组织的再生过程?了解：细胞再生的调控机制影响创伤愈合的因素Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time 修复过程始于炎症活的机体才有修复反应Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time?修复（repair）的概念：机体对因损伤造成的部分

3、细胞、组织的缺失进行修补，完全或部分恢复组织的结构和功能。?参与修复过程的主要成分：参与修复过程的主要成分：?细胞外基质?各种细胞Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time?修复的形式：?完全再生周围同种细胞增生，完全恢复原组织结构功能。?纤维性修复由纤维组织填补，以后形成瘢痕。Our greatest weak ness lies in giving up.The most certain way to succeed

4、is always to try just one more time 第一节再生(regeneration)Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time?生理性再生：新生的同种细胞不断补充老化、消耗的细胞、组织。完全再生。?举例：表皮角化细胞，子宫内膜，血细胞，呼吸消化道黏膜上皮?病理性再生：组织损伤后发生。完全再生或纤维性修复（不完全再生）。Our greatest weak ness lies in giving up

5、.The most certain way to succeed is always to try just one more time 一、细胞周期和不同类型细胞的再生潜能低等动物高等动物幼稚组织高分化组织易受损伤、须常更新的组织不常更新组织Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time?按再生能力的强弱，将人体细胞分为三类按再生能力的强弱，将人体细胞分为三类1.不稳定细胞（labile cell）：?持续分裂细胞（cont

6、inously dividing cell），组织中超过1.5%的细胞处于分裂期。存在干细胞。?例：表皮细胞淋巴及造血细胞间皮细胞呼吸道/消化道/男女生殖道管腔被覆细胞Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time 2.稳定细胞（stable cell）?静止细胞（quiescent cell）。生理情况下组织中处于分裂期的细胞1.5%。基本处于G0期。无干细胞。?受到刺激则进入DNA合成前期（G1期），表现出较强再生能力。?

7、例：各种腺体和腺样器官的实质细胞Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time 3.永久性细胞（permanent cell）?非分裂细胞（nondividing cell）。?例：神经细胞、骨骼肌细胞、心肌细胞神经干细胞肌肉干细胞Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one

8、more time 二、各种细胞的再生过程（一）上皮组织的再生1.被覆上皮再生：鳞状上皮、腺上皮Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time 2.腺上皮再生：基底膜 不复存在则难以再生。Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time 3.肝细胞再生：?肝部分

9、切除：肝细胞分裂再生，短期内恢复原大小。?肝细胞坏死，肝小叶网状支架完整?肝细胞广泛坏死，肝小叶网状支架塌陷Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time 假小叶Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time（二）纤维组织的再生间叶细胞静止态纤维细胞纤维细胞成

10、纤维细胞合成并分泌胶原蛋白胶原纤维Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time video0150201Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time（三）软骨组织和骨组织再生软骨膜骨膜纤维性骨痂成纤维细胞软骨细胞骨细胞Our greatest weak n

11、ess lies in giving up.The most certain way to succeed is always to try just one more time Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time（四）血管的再生1.毛细血管的再生：以生芽方式完成。可改建为小动、静脉。2.大血管的修复：手术吻合（显微外科）video0150202Our greatest weak ness lies in givi

12、ng up.The most certain way to succeed is always to try just one more time 基底膜溶解细胞增生细胞移动和趋化高通透性基底膜形成细胞管腔形成血管生成因子Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time（五）肌组织的再生1.横纹肌2.平滑肌：有一定再生能力。3.心肌：一般由瘢痕修复。肌膜保存，肌原纤维部分坏死残留肌细胞分裂产生肌浆，分化出肌原纤维肌膜及肌纤维均被

13、破坏纤维组织增生（瘢痕修复）Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time?（六）神经组织的再生1.神经元被破坏后，由神经胶质细胞及其胶质纤维修补。（胶质瘢痕）2.外周神经纤维受损：(video0150203)Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time 1

14、 2 3 4Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time 三、细胞再生的影响因素（一）细胞外基质（extracellular matrix，ECM）Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time 连接细胞，支撑和维持组织的生理结构和功能；影响细胞的形态、分化

15、、迁移、增殖和生物学功能。胚胎发育修复纤维化肿瘤侵袭Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time?主要成分：主要成分：1.胶原蛋白（collagen）：修复时，型胶原，型胶原，决定纤维组织强度。2.弹力蛋白（elastin）：决定纤维组织弹性。3.黏附性糖蛋白和整和素（integrin）（adhesive glycoprotein）Our greatest weak ness lies in giving up.The mo

16、st certain way to succeed is always to try just one more time?黏附性糖蛋白和整和素纤维连接蛋白（fibronectin）（E、）层粘连蛋白（laminin）（）整和素（integrins）（）：上皮细胞：成纤维细胞介导细胞-细胞外基质黏附改变细胞生长、形态、分化、运动增强血管内皮细胞对生长因子敏感性Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time 4.基质细胞蛋白一组

17、能影响细胞-基质相互作用的分泌性蛋白。骨连接素血栓粘合素骨桥蛋白（白细胞趋化因子）细胞粘合素（调控细胞粘附）Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time 5.蛋白多糖和透明质酸水合凝胶 透明质酸 硫酸软骨素 硫酸角质素 连接蛋白 核心蛋白 抑制细胞间黏附，促进细胞迁移Our greatest weak ness lies in giving up.The most certain way to succeed is alwa

18、ys to try just one more time（二）生长因子（growth factor）?作用：刺激同类或同一胚层发育来的细胞增生，并刺激细胞移动、收缩和分化。Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time 细胞损伤细胞因子生长因子G0细胞进入细胞周期、缩短细胞周期细胞外基质合成细胞接触性抑制第二信使Our greatest weak ness lies in giving up.The most certain

19、way to succeed is always to try just one more time 参与再生的主要生长因子种类及其作用参与再生的主要生长因子种类及其作用Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time（三）抑素（chalone）与接触抑制?抑素多来自增生组织本身，具有组织特异性。血管抑素、内皮抑素血小板反应蛋白1TGF-IFN-、PGE2、肝素成纤维细胞、平滑肌细胞上皮细胞血管内皮细胞Our greatest

20、weak ness lies in giving up.The most certain way to succeed is always to try just one more time 四、干细胞在细胞再生和组织修复中的作用?干细胞的概念：在个体发育过程中产生的具有无限或较长时间自我更新和多向分化能力的一类细胞。?研究干细胞的动机：完美地修复或替代因疾病、意外事故或遗传因素造成的组织、器官伤残。Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one

21、 more time?干细胞的类型?胚胎干细胞（embryonic stem cell）：起源于胚胎内细胞群的全能干细胞，具有向三个胚层分化的能力，可分化为成体所有类型的成熟细胞。Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time?成体干细胞(adult stem cell)：各组织器官中具有自我更新和一定分化潜能的不成熟细胞。?横向分化：部分成体干细胞可向本身组织分化，也可向无关组织类型的成熟细胞分化。Our greatest

22、weak ness lies in giving up.The most certain way to succeed is always to try just one more time 人造膀胱人造膀胱Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time 第二节纤维性修复Our greatest weak ness lies in giving up.The most certain way to succeed is alw

23、ays to try just one more time 肉芽组织granulation tissue溶解吸收损伤局部坏死组织和异物填补组织缺损胶原增生瘢痕过程：幼稚的纤维结缔组织Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time 一、肉芽组织的形态及作用（一）肉芽组织的成分及形态?光镜：光镜：?新生薄壁毛细血管?成纤维细胞?肌成纤维细胞?炎细胞Our greatest weak ness lies in giving up.T

24、he most certain way to succeed is always to try just one more time 新生薄壁毛细血管成纤维细胞炎细胞肌成纤维细胞Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time?肉眼观：?鲜红色，颗粒状?柔软湿润?形似鲜嫩的肉芽Our greatest weak ness lies in giving up.The most certain way to succeed is a

25、lways to try just one more time（二）肉芽组织的功能?填补伤口及其他组织缺损；?抗感染、去异物、保护创面；?机化或包裹坏死组织、异物、血凝块及炎性渗出物Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time（三）肉芽组织的结局：逐渐成熟瘢痕组织炎细胞多毛细血管多间质水分多成纤维细胞多吸收减少减少纤维细胞+大量胶原纤维玻璃样变减少消失改建成小动脉、小静脉Our greatest weak ness lies

26、 in giving up.The most certain way to succeed is always to try just one more time 二、瘢痕组织的形态及作用?瘢痕（scar）：肉芽组织成熟改建而成的纤维结缔组织。Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time 光镜：大量纵横交错分布的胶原纤维束，玻璃样变。肉眼观：色苍白，半透明，质韧，缺乏弹性。形态：Our greatest weak ness

27、lies in giving up.The most certain way to succeed is always to try just one more time?作用：?利：1.保持组织器官的完整性；2.高于肉芽组织的抗拉力。?弊：1.瘢痕收缩，功能障碍：例：关节挛缩、幽门梗阻2.瘢痕性粘连：胸膜腔粘连3.瘢痕组织过度增生瘢痕疙瘩(keloid)Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time Our greatest

28、 weak ness lies in giving up.The most certain way to succeed is always to try just one more time 三、肉芽组织和瘢痕组织的形成过程及机制（一）血管生成过程?间叶细胞血管内皮细胞(血管形成)?小血管出芽(血管生成)(VEGF)（二）纤维化?成纤维细胞增殖和迁移?细胞外基质积聚（三）纤维组织重构生长因子细胞-受体+金属蛋白酶家族Metalloprotease familyOur greatest weak ness lies in giving up.The most certain way to su

29、cceed is always to try just one more time 第三节创伤愈合（wound healing）Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time?概念：为各种组织再生、肉芽组织增生、瘢痕形成的复杂组合、协同作用。一皮肤创伤愈合Our greatest weak ness lies in giving up.The most certain way to succeed is always to t

30、ry just one more time（一）基本过程组织坏死、出血、炎症反应伤口收缩Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time 肉芽组织增生表皮再生瘢痕形成Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time（二）创伤愈合的类型1.一期愈合（healing

31、by first intention）愈合特点：少量坏死、血凝块少量肉芽组织炎症反应轻瘢痕组织少一周可达临床愈合标准Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time 2.二期愈合（healing by second intention）愈合特点：坏死组织多，炎症反应重伤口大，肉芽组织多炎症反应重愈合时间长，瘢痕组织大Our greatest weak ness lies in giving up.The most certain

32、 way to succeed is always to try just one more time 二、骨折(bone fracture)愈合Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time 三、影响创伤愈合的因素年龄营养感染和异物局部血液循环神经支配电离辐射是否及时正确复位是否牢固固定全身和局部功能锻炼（一）全身性因素（二）局部因素（三）影响骨折愈合的因素Our greatest weak ness lies in giv

33、ing up.The most certain way to succeed is always to try just one more time 小结修复的概念和形式完全再生纤维性修复细胞的再生能力不稳定细胞稳定细胞永久性细胞影响细胞再生的因素细胞的再生能力细胞外基质生长因子Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time 纤维性修复：肉芽组织成分作用结局皮肤创伤愈合的类型一期愈合二期愈合骨折愈合过程：新生毛细血管成纤维细胞

34、炎细胞瘢痕?抗感染/去异物/保护创面；?机化血凝块及坏死组织；?填补伤口及其他组织缺损血肿纤维性骨痂骨性骨痂骨痂改建Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time 思考题?修复的概念？?修复的方式？?按再生潜能，人体细胞分为几类，每类包括哪些细胞？?上皮、血管、纤维、肌组织和神经组织的再生方式？?肉芽组织的组成和功能？?肉芽组织如何转变为瘢痕组织？?瘢痕组织的作用？?骨折的愈合过程？骨折的愈合过程？?皮肤和软组织创伤愈合的类型？Our greatest weak ness lies in giving up.The most certain way to succeed is always to try just one more time