《病理学与病理生理学总论》1 总论绪论

傅国辉傅国辉Pathology & PathophysiologyIntroduction to 病理学与病理生理学是研究疾病病因、病理变化及发病机制、结局和转归的医学科学病因学： 疾病发生的原因发病学： 病因作用下疾病发生发展过程病理变化： 疾病过程中机体的功能、代谢和形态学变化临床病理联系： 病理变化引起的临床表现以及转归和结局等 The four aspects of a disease process that form the core of pathology Etiology： causes of the disease Pathogenesis： the mechanisms of its development Pathological change： the structural alteration induced in the cells and organs of the body. Clinical pathological correlation： the clinical effects of the pathological changes.What is pathologyIn its broadest sense, it is the study of how the organs and tissues of a healthy body change to those of sick person.It underpins every aspect of medicine, from diagnostic testing and monitoring of chronic diseases to cutting-edge genetic research and blood transfusion technologies. Pathology is integral to the diagnosis of every cancer.“Medicine IS Pathology”.Pathology is a branch of medical science which studies the nature, causes, developments, processes, consequences and effects of the diseases. Pathology emphasizes the structural changes. What is pathophysiology Pathophysiology is the study of functional changes in the body that occur in response to disease or injury. For example, if someone ingests a toxin, that toxin might be associated with a variety of physical changes, such as inflammation in the stomach lining or necrosis of the extremities. The field is designed to help people study the progress of disease so that they can quickly identify diseases and consider various treatment options.Patho- & PathophysiologyBasic MedicineClinic MedicineBridge病理知识和病理诊断是临床疾病诊断治疗的根本与依据病理生理学是治疗疾病及预测疾病转归的理论基础Both serves as a “bridge“ or “link“ between the preclinical sciences (anatomy, physiology, etc.) and the courses in clinical medicine.Every Disease Has A Pathologic BasisPneumoniaPneumonia Normal lung A bridging discipline involving both basic science and clinical practice. Devoted to the study of the structural and functional changes in cells, tissues and organs that underlie disease. To explain the whys and wherefores of the signs and symptoms of the patients. Providing a sound foundation for rational clinical care and therapy.bridgingBasic medicinePathology & pathphysiologyClinical medicineMolecular biology Molecular pathologyBiotherapyTargeting therapyIndividual therapy(1) Pathology is a bridging between basic science and clinical medicine(2) Pathology is also a practical clinic medicine ( Diagnostic Pathology or Surgical Pathology) (3) Pathophysiology as a bridge not between the basic science and diseases but various basic sciences.(4) Pathophysiology enabling the students, clinicians and other practitioners to understand why and how diseases develop and various clinical manifestations appear, and what are the fundamental mechanisms. Position(1) Human pathology The principal aim of human pathology considers structural abnormalities of cells and tissues grossly and microscopically examined from patients tissues (2) Experimental pathologyExperimental pathology researches cellular processes incorporate animal experiment and tissue and cell culturesClassification1. Human pathology(1) Autopsy (means “see for yourself”)Autopsy is a special operation, performed by specially trained physician, on a dead body尸体解剖 (autopsy) 对死者的遗体进行病理剖验The functions of autopsy Clarify the causes of death Diagnosis and treatment quality control Recognizing of negligence Recognition of new diseases and new diseases patterns Source of information Provide material for education and scientific research Recognition of treatment effectiveness意义：确定死因；提高医疗质量；发现特殊疾病；收集、积累各种疾病的病理资料等 Biopsy is the removal of a sample of tissue from the body for examination and the tissue will be examined under a microscope to assist in diagnosis (2) Biopsy活组织检查 (biopsy) 对活体组织采用局部切除、钳取、针吸、搔刮等方法，进行取材检查意义： 在活体情况下对患者作出诊断；术中诊断，协助选择术式和手术范围；随诊观察病情，判断疗效；组织化学和细胞化学等方法进一步诊断(3) CytologyCytology is responsible for preparation, staining and microscopic examination. (smear, fine needle aspiration)2. Experimental pathology(1) Animal experiment: Animal experiment is a pathological method using animal model to study diseases within the body.(2) Tissue and cell cultureTissue and cell culture is that the tissue or cell sample from a human or animal is obtained and maintained in vitro for experimental, diagnostic or therapeutic purposes(1) Gross appearanceThe morphological feature of a lesion (such as size, shape, weight, color, consistency, surfaceedge, section) is observed by eyes or assisted by using a ruler, steelyard, magnifying glass, or other tools.Basic examination methods(2) Histologic and cytologic observationThe specimens from patients are prepared as a section or smear, then stained and examined by using microscopy 超微结构观察 Ultrastructural observation:用透射和扫描电镜对细胞内部或表面亚细胞水平超微结构进行观察形态计量和图像分析技术 Morphometry and image analysis technology :对组织和细胞的形态因素和 显色反应结果进行定量研究分子生物学技术 Molecular biology technology 包括PCR、原位杂交 、 实现对 DNA、 RNA、 蛋白质等大分子进行定性、定位和定量检查cytologic observationHistologic observationmost common: basic formalin fixed HE (hematoxylin and eosin) stained（ 3） Histochemistry and cytochemistryHistochemistry and cytochemistry is also called special stain method. Some tissue structures and substances (protein, enzyme, nucleic acid, glycogen, lipid) are colored when a chemical group ( carboxyl, phosphoric, or aldehyde) reacts with the stain PAS (glycogen) BM Sudan fat病理科的常规工作流程取材固定脱水 包埋 切片染色诊断大体观察： 大小、形态、重量、色泽、质地、表面及切面状况组织学与细胞学观察： 取病变组织制成切片或细胞学涂 片，经不同染色后用光镜观察 组织化学与免疫组织化学观察： 前者是利用某种显色剂 能与不同化学成分特 异性结合的特性，显示细 胞结构中蛋白质、酶类、核酸、糖类、脂类等细胞化学成分后者是利用已知抗原与抗体特异性的 结合，来检测组织细胞中未知的抗体或抗原Immunohistochemistry Ag-Ab