细胞与组织的适应与损伤(1)PPT课件.ppt

第二章组织与细胞的适应与损伤(AdaptationandInjury),1,WuFeng,SouthwestHospital,TMMU,损伤的形式与形态学变化可逆性损伤ReversibleInjury,2,WuFeng,SouthwestHospital,TMMU,变性（degeneration）变性的概念由于某些原因引起细胞代谢障碍，使细胞或间质内出现正常物质过多或出现异常物质的形态学改变。,3,WuFeng,SouthwestHospital,TMMU,4,正常细胞,脂肪肝细胞,异常代谢,蛋白结构或运输异常,异常蛋白的蓄积,WuFeng,SouthwestHospital,TMMU,5,酶的缺失,外源性物质摄入,内源性物质蓄积,外源性物质蓄积,WuFeng,SouthwestHospital,TMMU,细胞水肿cellularswelling,cellularhydropicdegeneration概念由于某些原因损伤细胞的线粒体，ATP生成减少，细胞膜Na-K泵受损、膜损伤，引起细胞内水、钠增多，细胞体积增大。,6,WuFeng,SouthwestHospital,TMMU,细胞水肿的原因缺血、缺氧感染中毒,7,WuFeng,SouthwestHospital,TMMU,细胞水肿,8,脑水肿,WuFeng,SouthwestHospital,TMMU,细胞水肿,9,肝组织水肿,WuFeng,SouthwestHospital,TMMU,细胞水肿,10,WuFeng,SouthwestHospital,TMMU,11,细胞水肿,细胞水肿,WuFeng,SouthwestHospital,TMMU,细胞水肿,12,细胞水肿,WuFeng,SouthwestHospital,TMMU,脂肪变性（fattydegeneration）概念由于某些原因引起细胞的脂肪代谢障碍，中性脂肪特别是甘油三酯蓄积于细胞质中，使除脂肪细胞外的细胞中出现脂滴或脂滴明显增多。,13,WuFeng,SouthwestHospital,TMMU,脂肪变性的原因营养障碍感染中毒缺氧酗酒糖尿病、肥胖,14,WuFeng,SouthwestHospital,TMMU,游离脂肪酸,醋酸,氧化成酮体,磷脂,胆固醇酯,甘油三酯,脂蛋白,脂质积累,肝脂肪变性的机制,载脂蛋白,-甘油磷脂,脂肪酸,WuFeng,SouthwestHospital,TMMU,脂肪变性,16,肝脂肪变性,WuFeng,SouthwestHospital,TMMU,脂肪变性,17,脂肪变性,WuFeng,SouthwestHospital,TMMU,脂肪变性,18,脂肪变性,WuFeng,SouthwestHospital,TMMU,脂肪变性,19,脂肪变性,WuFeng,SouthwestHospital,TMMU,脂肪变性,20,WuFeng,SouthwestHospital,TMMU,心肌脂肪浸润,21,脂肪变性,WuFeng,SouthwestHospital,TMMU,透明变性（hyalinedegeneration），又称玻璃样变概念细胞内或间质中出现了对伊红有易染性，呈红染、均质无结构、半透明、具有折光性的蛋白质蓄积。,22,WuFeng,SouthwestHospital,TMMU,透明变性的类型及意义其物理性状大致相同，但其病因、发生机制、功能意义及其化学成分不同血管壁高血压之细、小动脉结缔组织瘢痕细胞内吞饮蛋白质、胞质灶性变性等,23,WuFeng,SouthwestHospital,TMMU,脾,透明变性,24,WuFeng,SouthwestHospital,TMMU,结缔组织,透明变性,25,结缔组织透明变性,WuFeng,SouthwestHospital,TMMU,26,肾小球透明变性,肾小球透明变性,WuFeng,SouthwestHospital,TMMU,血管壁透明变性,27,血管壁透明变性,WuFeng,SouthwestHospital,TMMU,透明变性,28,肾小管透明变性,WuFeng,SouthwestHospital,TMMU,透明变性,29,WuFeng,SouthwestHospital,TMMU,透明变性,30,细胞内透明变性,Mallory小体,WuFeng,SouthwestHospital,TMMU,淀粉样变amyloiddegeneration概念细胞间质出现淀粉样蛋白（蛋白-黏多糖复合物，-淀粉样蛋白及其前体）沉积。淀粉样物+碘褐色淀粉样物+硫酸蓝色淀粉样物+刚果红染色橘红色,31,WuFeng,SouthwestHospital,TMMU,淀粉样变的类型及意义全身性淀粉样变慢性化脓性炎、慢性空洞性肺结核、骨髓瘤等局部性淀粉样变慢性炎症、糖尿病、某些淋巴瘤、神经内分泌肿瘤,32,WuFeng,SouthwestHospital,TMMU,淀粉样变,33,WuFeng,SouthwestHospital,TMMU,淀粉样变,34,WuFeng,SouthwestHospital,TMMU,黏液变性（mucoiddegeneration）概念组织间质内出现类黏液黏多糖（葡萄糖胺聚糖、透明质酸等）和蛋白质的积聚。,35,WuFeng,SouthwestHospital,TMMU,黏液变性的意义见于间叶性肿瘤、急性风湿病、动脉粥样硬化的血管壁、甲状腺功能低下等疾病。,36,WuFeng,SouthwestHospital,TMMU,脂肪肉瘤，黏液样变,37,脂肪肉瘤，粘液样变,WuFeng,SouthwestHospital,TMMU,软骨肉瘤，黏液样变,38,软骨肉瘤，粘液样变,WuFeng,SouthwestHospital,TMMU,黏液样变,39,粘液样变,WuFeng,SouthwestHospital,TMMU,病理性色素沉着概念组织内各种色素（内、外源性）的沉着。,40,WuFeng,SouthwestHospital,TMMU,含铁血黄素（hemosiderin）巨噬细胞吞噬红细胞后在胞质内由铁蛋白微粒集结形成大小不一、金黄或棕黄色、具有折光性的一种色素。普鲁蓝反应：Fe3+铁氰化钾+盐酸蓝色,41,WuFeng,SouthwestHospital,TMMU,含铁血黄素,42,含铁血黄素,WuFeng,SouthwestHospital,TMMU,含铁血黄素,43,含铁血黄素,WuFeng,SouthwestHospital,TMMU,脂褐素（lipofuscin）细胞内自噬溶酶体中的细胞器碎片，未被溶酶体酶消化而形成的不溶性残存小体（磷脂和蛋白质混合）的黄褐色细颗粒状色素。,44,WuFeng,SouthwestHospital,TMMU,45,脂褐素,WuFeng,SouthwestHospital,TMMU,脂褐素,46,脂褐素,WuFeng,SouthwestHospital,TMMU,黑色素（melanin）细胞质中由酪氨酸氧化经左旋多巴聚合生成的大小、形态不一的棕褐色或深褐色颗粒状色素。,47,WuFeng,SouthwestHospital,TMMU,Melanoma,Nevus,48,黑色素,WuFeng,SouthwestHospital,TMMU,Melanoma,49,黑色素瘤，Fontana-Masson染色,WuFeng,SouthwestHospital,TMMU,黑,白,黄,彩,WuFeng,SouthwestHospital,TMMU,病理性钙化营养不良性钙化(dystrophiccalcification)体内钙磷代谢正常，而在变性坏死组织、异物等中的钙盐沉积。,51,WuFeng,SouthwestHospital,TMMU,主动脉瓣，钙化,52,主动脉瓣钙化,WuFeng,SouthwestHospital,TMMU,钙化,53,血管壁钙化,WuFeng,SouthwestHospital,TMMU,钙化,54,动脉中层钙化,WuFeng,SouthwestHospital,TMMU,转移性钙化(metastaticcalcification)全身性钙磷代谢障碍，血钙或血磷增高所致的某些未损伤的组织中的钙盐沉积。,55,WuFeng,SouthwestHospital,TMMU,肺，迁徙性钙化,56,肺，转移性钙化,WuFeng,SouthwestHospital,TMMU,损伤的形式与形态学变化不可逆性损伤InreversibleInjury,57,WuFeng,SouthwestHospital,TMMU,细胞死亡(celldeath)细胞因受严重损伤而累及细胞核时，呈现代谢停止、结构破坏和功能丧失等不可逆性变化即细胞死亡。,58,WuFeng,SouthwestHospital,TMMU,坏死（Necrosis）概念活体的局部组织、细胞死亡后经水解酶作用所表现的形态学改变。,59,WuFeng,SouthwestHospital,TMMU,坏死的病变1细胞核核浓缩（pyknosis）即细胞核染色质DNA凝聚、皱缩，使核体积缩小，嗜碱性染色增强，又称为核固缩。,60,WuFeng,SouthwestHospital,TMMU,61,核固缩,WuFeng,SouthwestHospital,TMMU,核碎裂（karyorrhexis）即核染色质崩解和核膜破裂，细胞核碎裂成小块、分散在胞质中，也可由核固缩裂解而成。,62,WuFeng,SouthwestHospital,TMMU,心肌坏死,63,WuFeng,SouthwestHospital,TMMU,核溶解（karyolysis）即细胞核在激活的非特异性DNA酶和蛋白酶的作用下，核DNA和核蛋白分解，核染色质嗜碱性下降、甚至只能见核的轮廓。,64,WuFeng,SouthwestHospital,TMMU,肾坏死,65,WuFeng,SouthwestHospital,TMMU,坏死的类型1凝固性坏死（coagulativenecrosis）概念坏死组织由于蛋白变性凝固、水解酶作用弱和失水变干而成灰白或黄白色、质实的凝固体。,66,WuFeng,SouthwestHospital,TMMU,脾,肝,脾,心,肾,67,WuFeng,SouthwestHospital,TMMU,心肌梗死,Normal,68,心肌梗死,WuFeng,SouthwestHospital,TMMU,急性重型肝炎,69,急性重型肝炎,WuFeng,SouthwestHospital,TMMU,70,肾,肾梗死,WuFeng,SouthwestHospital,TMMU,2干酪样坏死（caseousnecrosis）概念坏死组织轮廓消失，形成无定形的颗粒状，含有较多脂质而呈黄色、状似干酪，主要见于结核病。,71,WuFeng,SouthwestHospital,TMMU,72,WuFeng,SouthwestHospital,TMMU,73,WuFeng,SouthwestHospital,TMMU,抗酸染色,74,干酪样坏死,WuFeng,SouthwestHospital,TMMU,3坏疽（gangrene）概念大片组织坏死后继发不同程度的腐败细菌（常为梭状芽孢杆菌属厌氧菌和奋森螺旋体等）感染和其他因素（如硫化氢）的影响而呈黑色等特殊形态改变的坏死。,75,WuFeng,SouthwestHospital,TMMU,坏疽的病变类型及特点1干性坏疽（drygangrene）多发生于肢体血管病变或冻伤时，动脉阻塞、静脉回流无障碍的肢体远端缺血性坏死，继发腐败菌感染，坏死区干燥皱缩呈黑色，与正常组织界限清楚。,76,WuFeng,SouthwestHospital,TMMU,77,干性坏疽,WuFeng,SouthwestHospital,TMMU,2湿性坏疽（wetgangreneormoistgangrene）多发生于内脏器官（如肺、肠、子宫、胆囊等）或动脉阻塞伴静脉回流障碍肢体等的坏死，继发腐败菌感染，坏死区水分较多，肿胀呈蓝绿色，与周围正常组织界限不清。,78,WuFeng,SouthwestHospital,TMMU,79,湿性坏疽,WuFeng,SouthwestHospital,TMMU,80,湿性坏疽,WuFeng,SouthwestHospital,TMMU,81,湿性坏疽,WuFeng,SouthwestHospital,TMMU,3气性坏疽（gasgangrene）深在的开放性创伤合并产气荚膜杆菌、恶性水肿杆菌、腐败弧菌等厌氧菌感染，组织坏死并产生大量气体。,82,WuFeng,SouthwestHospital,TMMU,83,G+,气性坏疽,WuFeng,SouthwestHospital,TMMU,2液化性坏死（liquefactivenecrosis）概念坏死组织中可凝固的蛋白质少、组织富含水和磷脂、坏死细胞或浸润的中性粒细胞释放大量水解酶使坏死组织细胞溶解、液化而呈液状。,84,WuFeng,SouthwestHospital,TMMU,85,脑液化性坏死,WuFeng,SouthwestHospital,TMMU,86,脑液化性坏死,WuFeng,SouthwestHospital,TMMU,87,脑液化性坏死,WuFeng,SouthwestHospital,TMMU,2脂肪坏死（fatnecrosis）概念脂肪组织坏死、脂肪酸与钙盐结合而呈散在的混浊、灰白略带黄色的斑点状或小结节状。,88,WuFeng,SouthwestHospital,TMMU,89,WuFeng,SouthwestHospital,TMMU,90,WuFeng,SouthwestHospital,TMMU,3纤维蛋白样坏死（fibrinoidnecrosis）/纤维蛋白样变性（fibrinoiddegeneration）概念结缔组织的胶原纤维及血管壁的组织坏死，呈细丝状、颗粒状或小块状的无结构物质，其染色性与纤维蛋