病理学课件：呼吸系统疾病

呼吸系统疾病

Thelungandtheupperrespiratorytract病理学呼吸系统的组成正常结构Conductiveregionandrespiratoryregionbasedontheirfunctions:TracheaandbronchiBronchiolesTerminalbronchiolesRespiratorybronchiolesAlveolarductsAlveolarsacAlveoliAcinusLobulecartilageChronicobstructivepulmonarydisease慢性阻塞性肺病Cor

pulmonale

肺源性心脏病Pneumonia肺炎Lungcancer肺癌一组由各种原因引起的，以肺实质和小气管受损后，导致慢性不可逆性气道阻塞、呼气阻力增加及肺功能不全为共同特征的肺疾病，主要包括慢支、肺气肿、支气管哮喘、支扩等疾病。慢性阻塞性肺病（COPD），Chronicobstructivepulmonarydiseaseaffectsmorethan10%oftheUSadultpopulationandisthefourthleadingcauseofdeathinthiscountry.RobinBasicPathology9th慢性支气管炎与细支气管炎ChronicbronchitisandbronchiolitisDiagnosisofchronicbronchitis：

Apersistentproductivecoughforatleast3consecutivemonthsinatleast2consecutiveyearsPathogenesis：Cigarettesmoking：thesinglemostimportantcauseInfection:Airpollution：Allergicfactor:asthmaticbronchitisOthers:Pathologicchanges：

Beginningfromlargeairway,followedbysmallerbronchiandbronchioles

上皮的损伤与修复Epithelialinjuryandrepair腺体的增生、肥大与化生Enlargementofmucus-secretingglandsandgobletcellmetaplasia慢性非特异性炎InflammationandfibrosisinthewallsClinicalcourse：咳嗽、咳痰、喘息productionofsputum,Progression：肺气肿emphysema肺气肿肺气肿(Emphysema)呼吸性细支气管、肺泡管、肺泡因肺组织弹性减弱而过度充气，呈永久性扩张，并伴肺泡间隔破坏，致使肺容积增大、肺功能降低的病理状态。肺气肿EmphysemaDefinition:

Permanentenlargementoftheairspacesdistaltotheterminalbronchiolesaccompaniedbydestructionoftheirwalls.RobinBasicPathology9thPathogenesis:支气管阻塞性通气功能障碍Partialobstruction：e.g.chronicbronchiolitis弹性蛋白酶及其及其抑制物失衡Protease-antiproteaseimbalance：e.g.

α1-antitrypsindeficiencySmoking:WBCactivationPathologicchanges：3types:腺泡中央型：Centriacinaremphysema全腺泡型：Panacinaremphysema腺泡周围型：DistalacinaremphysemaCentriacinaremphysema:RespiratorybronchiolesaffectedDistalalveolisparedMorecommonintheupperlobeAconsequenceofsmokingPanacinaremphysema:ThewholeaciniuniformlyenlargedAconsequenceofα1-antitrypsindeficiencyDistalacinaremphysema:AdjacenttothepleuraMoresevereintheupperhalfofthelung大泡型肺气肿Others:代偿性肺气肿Compensatoryemphysema老年性肺气肿Senileemphysema阻塞性过度通气Obstructiveoverinflation间质性肺气肿InterstitialemphysemaClinicalcourse:渐进性呼气性呼吸困难progressivedyspnea,pulmonaryfunctionreducedComplications：肺心病Corpulmonale自发性气胸SpontaneouspneumothoraxInfection支气管扩张症BronchiectasisDefinition：以肺内支气管的持久性扩张为特征的慢性疾病ThepermanentdilationofbronchiandbronchiolescausedbydestructionofthemuscleandelasticsupportingtissuePathogenesis：Itisnotaprimarydisease，butrathersecondarytopersistinginfectionorobstructioncausedbyavarietyofconditions.RobinBasicPathology9th病因病机：支气管壁的炎性损伤：婴幼儿百日咳、麻疹后的支气管肺炎、慢支、肺结核…

支气管先天性发育缺陷和遗传因素Pathologicchanges：Grossly：bronchialdilation,usuallyaffectthelowerlobes

moredistal,moreseverefullofpurulentexudateLM：chronicinflammationnecrosisandfibrosisinthewallClinicalcourse：慢性咳嗽Persistentcough，大量脓痰Mucopurulent,sometimesfetid,sputum咯血HemoptysisComplications：pneumonia,pulmonaryabscess,pulmonaryhypertensionandrarelycorpulmonalepulmonaryheartdisease慢性肺源性心脏病:由慢性肺疾病、肺血管疾病及胸廓运动障碍性疾病引起肺循环阻力增加、肺动脉压力增高，以右心室肥厚、扩张为特征的心脏病，称为pulmonaryheartdisease（colpulmonale），简称肺心病。Pathogenesis：肺部疾病Diseasesoflungs:e.g.COPD肺血管疾病Diseasesofpulmonaryvessels胸廓运动障碍DisordersaffectingchestmovementPathologicchanges：Pulmonarylesions：原有肺部病变肺小血管病变ThedecreaseintheamountofpulmonaryvascularbedIntimathickenedandSMChyperplasiaLesionsinheartTherightventricularhypertrophyanddilation

肺动脉瓣下2㎝处右心室肌壁厚≥5mmClinicalcourse：原有肺部疾病或胸廓疾病的症状与体征respiratoryinsufficiency呼吸性酸中毒与肺性脑病

respiratoryacidosisandcoma右心衰Right-sidedheartfailure肺炎PneumoniaClassification:Lobarpneumonia/bronchopneumonia/interstitialpneuomoniaBacterial/viralpneuomiaOthers:大叶性肺炎Lobarpneumonia：急性炎症Acuteinfection肺炎双球菌感染PneumococcallunginfectionLowerlobesortherightmiddlelobe变态反应性炎，弥漫性纤维素性炎DiffusedfibrinousinflammationFourstages:

充血消肿期Congestion

红色肝变期Redhepatization

灰色肝变期Greyhepatization

溶解消散期ResolutionCongestion:1-2nddaysGrossly:theaffectedlobe(s):heavy,red,andboggyLM:充血水肿vascularcongestion

浆液性渗出pinkexudatewithbacteriainthealveoliRedhepatization:3–4thdaysGrossly:redandenlarged,aliver-likeconsistency

Redhepatization:LM:渗出物含大量红细胞与纤维素thealveoliarefilledwithRBCandfibrin,Greyhepatization:5-6thdaysGrossly:thelungisdry,greyandfirmLM:渗出物含大量纤维素与白细胞alveoliarefilledwithfibrinousexudateandWBCbacteriaarekilledanddegraded

Resolution:the2ndweek炎性渗出物溶解消散，肺组织结构完整TheexudatesaredigestedbyWBC,leavingthebasicarchitectureintact.Complications：并发症少见Rarely,lungabscess,empyema,

septemia,septicshock…纤维素性胸膜炎肺肉质变Pulmonarycarnification小叶性肺炎Lobularpneumonia（bronchopneumonia）：混合感染Multiplebacteriainfection肺小叶为单位Extensionintothewholelobules局灶性化脓性炎FocalPurulentinflammationPathologicchanges:

Thelesionsaredistributedinpatchesthroughoutoneorseverallobes,mostfrequentlybilateralandbasal.ConfluencemayoccurinseverecasesLM：细支气管与周围组织大量中性粒细胞渗出Thebronchiolesandadjacentalveoliarefullofpurulentexudates.病灶间组织结构完整Theinterveningareasarenormal支气管及肺泡壁遭破坏Thebasicarchitecturesareofteninjured.

Clinicalcourse:

fever,cough,purulentsputum…Complications：并发症多见，且预后较差

Lungabscess,empyema,

septemia,septicshock…病毒性肺炎Viralpneumonia:ViralinfectionMorefrequentinchildren急性间质性肺炎InterstitialpneumoniaClinicalcourse：

Fever,headache,干咳Nonproductivecough,Hypoxia,dyspnea肺硅沉着症SilicosisSiO2粉尘吸入我国最常见的职业病之一OccupationaldiseasePathologicchanges：硅结节的形成Silicoticnodulesformation弥漫性纤维化DiffusedfibrosisThreestages：StageⅠ：silicoticnoduleslocatedinhilarlymphnodesStageⅡ：silicoticnoduleslimitedin1/3oflungs.Thelungsgetenlargedandconsolidated.

StageⅢ：silicoticnodulesgetincreasedinsizeandquantity.Thelungsgetheavierandfirm.Thepleuragetthickened.Complications：结核Tuberculosis肺心病Colpulmonale感染PulmonaryinfectionOthers…LungandbronchuscancerRoughly95%ofprimarylungtumorsarecarcinomas;…..Carcinomaofthelung(alsoknownas“lungcancer”)iswithoutdoubtthesinglemostimportantcauseofcancerrelateddeathsinindustrializedcountries.

RobinBasicPathology9thWorldCancerReport2014CancerStatistics,2013CACANCERJCLIN2013;00:000–0002013中国肿瘤登记年报Causes：Smoking:About90%oflungcancersoccurinactivesmokersorthosewhostoppedrecently.RobinBasicPathology9thAirpollution:Geneticfactor:p53,K-ras,…Pathologicchanges：

Grossly：中央型：Centralhilarmasses周围型：Peripheralnodules弥漫型：MultiplediffusednodulesHistologicclassification:鳞状细胞癌Squamouscellcarcinoma小细胞癌Smallcelllungcarcinoma腺癌Adenocarcinoma大细胞未分化癌LargecellcarcinomaSquamouscellcarcinoma:MorefrequentinmalesStrongassociationwithcigarettesmokingPrecededbysquamousmetaplasiaanddysplasiainbronchi