血液与肌组织

1、血 液 Blood血 浆plasma: 55% 血小板 Platelets血浆白细胞，血小板血细胞血液不加抗凝剂即凝固成块，周围析出的淡黄色清明液体。血清 serum:组成:血象 hemogram 定义：是血细胞形态、 数量、比例及血红蛋白含量的测定。血涂片的常用染色方法是Wright或Giemsa染色。意义：血象的变化是多种疾病诊断、预后及治疗效果的重要指标。血 细 胞 红细胞 femal (3.55.5) *1012/L mal （4.0-5.5）*1012/L 白细胞 （410）109 /L 血小板 （100300）109/ L 中性粒C 有粒白细胞 嗜酸性粒C 嗜碱性粒C无粒白细胞 淋

2、巴细胞 单核细胞 红细胞 erythrocyte, red blood cell 大小：形状：双凹圆盘状。结构特点：无核，无细胞器内含物：充满血红蛋白(Hb)红细胞骨架:HB正常值：血型：血影:临床联系 Medical Application A decreased number of erythrocytes in the blood is usually associated with anemia（贫血）. An increased number of erythrocytes (erythrocytosis, or polycythemia红细胞增多症) may be a physio

3、logic adaptation. Polycythemia which is often associated with diseases of varying degrees of severity, increases blood viscosity;Polycythemia might be better characterized as an increased hematocrit红细胞压积. Erythrocytes with diameters greater than 9 m are called macrocytes, and those with diameters le

4、ss than 6m are called microcytes. 网织红细胞（reticulocyte)骨髓进入血液的未完全成熟的红细胞。用煌焦油蓝染色网织红细胞内有染成蓝色的颗粒或细网，是残留的核糖体。网织红细胞进入外周血13天后，核糖体完全消失。网织红细胞计数常作为判断骨髓造血能力的重要指标。成人0.5-1，新生儿高达3-6。 人血涂片示网织红细胞 (煌焦油蓝染色)白细胞(leukocytes, white blood cell, WBC)WBC有粒细胞无粒细胞中性粒细胞嗜酸性粒细胞嗜碱性粒细胞淋巴细胞单核细胞 分类依据：根据细胞质内有无特殊颗粒和颗粒的嗜色性。中性粒细胞 neutrop

5、hil（50%70 %）直 径：细胞核：胞 质:两种特殊颗粒 （嗜天青颗粒 特殊颗粒）核左移（1-2叶）:核右移（4-5叶）:功 能： 趋化作用 吞噬功能 嗜酸性粒细胞 eosinophil（0.5 %5 % )核多2 叶，胞质内充满粗大的鲜红色嗜酸性颗粒，含组胺酶、芳基硫酸酯酶、阳离子蛋白、过氧化物酶等。功能：抑制过敏反应, 杀灭寄生虫。3.嗜碱性粒细胞 basophil（01 %）形态：细胞质：细胞核功能：与肥大细胞相似参与过敏反应 三种有粒白细胞比较中性粒细胞嗜酸性粒细胞嗜碱性粒细胞直 径 细胞核胞 质正常值和寿 命功 能 淋巴细胞 lymphocyte（20 % 40 %)T 细胞B

6、细胞NK 细胞形态：胞质嗜碱性； 核圆形，占细胞的大部分。根据发生部位、表面特征、免疫功能和寿命不同可分类为：分类：单核细胞 monocyte 3%8%形态： 细胞表面微绒毛胞质内有吞噬泡颗粒有溶酶体样结构功能：参与免疫两种无粒白细胞比较单核细胞淋巴细胞大小细胞核功能血小板（LM）Blood platelet血小板（EM）Blood platelet特殊颗粒、致密颗粒、溶酶体血小板platelet功能：止血和凝血.血管受损破裂血栓血小板黏附血块纤维蛋白原纤维蛋白临床联系 Medical Application Hemophilia（血友病） A and B are clinically ide

7、ntical, differing only in the deficient factor. Both are due to sex-linked recessive inherited disorders. Blood from hemophiliac patients does not coagulate normally: Persons with this disease bleed severely even after mild injuries, such as a skin cut, and may bleed to death after more severe injur

8、ies. The blood plasma of patients with hemophilia A is deficient in clotting factor VIII or contains a defective factor VIII; in hemophilia B, the defect is in factor IX. In severe cases the blood is incoagulable. Generally, only males are affected by hemophilia A, because the recessive gene to fact

9、or VIII is in the X chromosome. Females develop hemophilia only when they have the abnormal gene in both X chromosomes.骨髓和血细胞发生造血器官胚胎时期造血各器官的演变 6W 4-5M 出生后 卵黄囊肝脾 骨髓骨髓的结构 红骨髓：造血组织+血窦 黄骨髓: 脂肪组织+少量的幼稚血细胞骨髓光镜结构造血组织：网状组织+造血细胞造血诱导微环境（hemopoietic inductive microenvironment）： 是造血细胞赖以生长发育的环境。包括：骨髓的神经成分、微血管系统

10、和结缔组织。它们不仅起支架作用，还分泌多种细胞体液因子，调节造血细胞的增殖与分化。造血干细胞 hemopoietic stem cell 又称多能干细胞（multipotential stem cell）起源：卵黄囊等处的血岛，出生后主要位于红骨髓、脾和淋巴结，少量于外周血形态：类似小淋巴细胞，即细胞体积小，核相对较大，胞质富含核糖体特性：强增殖潜能 多向分化 自我复制，终身保持数量恒定。 血细胞发生图血细胞发生过程中的形态演变原始阶段 幼稚阶段 成熟阶段。1.胞体由大到小,巨核细胞由小到大2.胞核由大到小;红细胞核最后消失；粒细胞核变成杆状到分叶;巨核细胞核由小变大到分叶;核着色由浅到深。3

11、.胞质量由少渐多,嗜碱性渐变弱(除淋巴细胞和单核细胞),出现特殊物质。4.细胞分裂能力从有到无(淋巴细胞除外)。 临床联系 Medical Application Growth factors have been used clinically to increase marrow cellularity and blood cell counts. The use of growth factors to stimulate the proliferation of leukocytes is opening broad new applications for clinical thera

12、py. increasing the efficiency of marrow transplants by enhancing cell proliferation; enhancing host defenses in patients with malignancies and infectious and immunodeficient diseases; and enhancing the treatment of parasitic diseases. Hematopoietic diseases are usually caused by suppression or enhan

13、cement of some undifferentiated cell production, with a consequent reduction or overproduction of hematopoietic cells. In some diseases, however, suppression and enhancement of proliferation of more than one type of stem cell can occur, sequentially or simultaneously. 肌 组 织Muscle tissue米隆：掷铁饼者肌肉组织的分

14、类骨骼肌心肌平滑肌特殊名词: 1、肌细胞肌纤维 2、细胞膜肌膜 3、细胞质肌浆 4、SER 肌浆网 骨 骼 肌光镜结构:胞体：长圆柱状，胞核:数十至数百个,位周边胞质：充满肌原纤维， 与肌纤维长轴平行排列， 有周期性横纹肌节 sarcomere定义:相邻2条Z线之间的一段肌原纤维，由1/ 2 I 带+A带+1/ 2 I 带构成，是骨骼肌纤维结构和功能的基本单位暗带（A带）,中央有H 带,H 带中央有M 线明带（I 带）,中央为Z 线二、骨骼肌纤维的超微结构1、肌原纤维 粗肌丝和细肌丝构成；肌原纤维间有肌浆网，大量线粒体、糖原、肌红蛋白粗肌丝肌球蛋白头（ATP酶）杆细肌丝 肌动蛋白（肌球蛋白头部

15、结合位点) 原肌球蛋白 肌钙蛋白（可与Ca2+ 结合)肌动蛋白：两条相互缠绕串珠状螺旋链组成。原肌球蛋白：双股螺旋多肽链,嵌于肌动蛋白双股螺旋两侧的浅沟内。肌原蛋白：由3个球形亚单位组成，细肌丝的分子结构2 、横小管transverse tubule位置：明带、暗带交处。形成：肌膜凹陷于肌质 成。功能：传递膜电位。肌膜向肌浆内凹陷形成的管状结构，与肌纤维长轴垂直，同一平面的横小管分支吻合，环绕肌原纤维3. 肌质网sarcoplasmic reticulum概念：特化的滑面内质 横小管之间结构：纵行包绕肌原纤维 纵小管 扁囊称终池三联体：每条横小管与两侧 的终池功能：贮存和释放Ca2+肌丝滑动原

16、理运动神经末梢将冲动传递给肌膜兴奋经横小管传递给肌浆网，释放Ca2+Ca2+与肌钙蛋白结合，使原肌球蛋白和肌钙蛋白构型变化，肌动蛋白上的肌球蛋白结合位点暴露，与肌球蛋白横桥结合ATP被分解释放能量，横桥弯，细肌丝牵向M 线细肌丝向M线滑动，明带、肌节、肌纤维收缩Ca2+ 被泵回肌浆网，肌钙蛋白等复原，肌纤维松弛舒缩时肌节的变化 临床联系 Medical application The variation in diameter of skeletal muscle fibers depends on such factors as the specific muscle and the age

17、 and sex, state of nutrition, and physical training of the individual. It is a common observation that exercise enlarges the musculature and decreases fat depots. The increase in muscle thus obtained is caused by formation of new myofibrils and a pronounced growth in the diameter of individual muscl

18、e fibers. This process, characterized by augmentation of cell volume, is called hypertrophy ；tissue growth by an increase in the number of cells is termed hyperplasia. Hyperplasia does not occur in either skeletal or cardiac muscle but does take place in smooth muscle, whose cells have not lost the

19、capacity to divide by mitosis. Hyperplasia is rather frequent in organs such as the uterus, where both hyperplasia and hypertrophy occur during pregnancy.临床联系 Medical Application Myasthenia gravis（重症肌无力） is an autoimmune disorder characterized by progressive muscular weakness caused by a reduction i

20、n the number of functionally active acetylcholine receptors in the sarcolemma of the myoneural junction. This reduction is caused by circulating antibodies that bind to the acetylcholine receptors in the junctional folds and inhibit normal nerve-muscle communication. As the body attempts to correct the condition, membrane segments with affected receptors are internalized, digested by lysosomes, and replaced by newly formed receptors. These receptors are again made unresponsive to acetylcholine by the same antibodies,