炎症1-徐芳英

白细胞游出
• 阿米巴运动的形式 • 早期以中性粒细胞为主，此后是单核细 胞。 • 根据致炎因子的不同，分别以中性粒细 胞、淋巴细胞和嗜酸性粒细胞为主。
内皮的活化
白细胞在内皮细胞上的滚动
白细胞粘着
白细胞游出
The multistep process of leukocyte migration through blood vessels, shown here for neutrophils. The leukocytes first roll, then become activated and adhere to endothelium, then transmigrate across the endothelium, pierce the basement membrane, and migrate toward chemoattractants emanating from the source of injury. Different molecules play predominant roles in different steps of this process-selectins in rolling; chemokines in activating the neutrophils to increase avidity of integrins (in green); integrins in firm adhesion; and CD31 (PECAM-1) in transmigration.
血管通透性增加
• 内皮细胞收缩和/或穿胞作用增强
– 发生于细静脉 – 内皮细胞的收缩是由于炎症介质出现所致
• 内皮细胞的损伤
– 累及所有微循环血管，包括毛细血管、细动脉和 细静脉 – 炎症早期白细胞黏附
• 新生毛细血管壁的高通透性
Diagrammatic representation of five mechanisms of increased vascular permeability in inflammation
Here is an example of the fibrin mesh in fluid with PMN's that has formed in the area of acute inflammation. It is this fluid collection that produces the "tumor" or swelling aspect of acute inflammation.
渗出液与漏出液
渗出液 • 漏出液
• • • • •
蛋白含量 15-60g/L 细胞数 ＞0.5×109/L 比重 >1.020 Rivalta试验 阳性 凝固性 自凝 透明度 混浊
<15g/L < 0.1×109/L <1.012 阴性 不自凝 澄清
液体渗出的意义
• • • • • 稀释毒素 带来营养物质，带走有害物质 带来大量抗体、补体用以消灭病原体 有利于吞噬和修复 压迫、阻塞和粘连、硬化
炎症时血流动力学改变
• 血流量和血管口径的改变 • 首先是细动脉短暂收缩； • 继而发生血管扩张、 血流加快、 此时局部 代谢增强、发红、发热。 • 血流速度减慢，血液粘稠度增加。
炎症早期的血管形态学改变
血管通透性增加
• 血管内流体静力压增高 • 血浆胶体渗透压下降 • 间质胶体渗透压增加
Blood pressure and plasma colloid osmotic forces in normal and inflamed microcirculation. A, Normal hydrostatic pressure (red arrows) is about 32 mm Hg at the arterial end of a capillary bed and 12 mm Hg at the venous end; the mean colloid osmotic pressure of tissues is approximately 25 mm Hg (green arrows), which is equal to the mean capillary pressure. hB, Acute inflammation. Arteriole pressure is increased to 50 mm Hg, the mean capillary pressure is increased because of arteriolar dilation, and the venous pressure increases to approximately 30 mm Hg. At the same time, osmotic pressure is reduced (averaging 20 mm Hg) because of protein leakage across the venule. The net result is an excess of extravasated fluid.
Here is an example of fluid collection into a body cavity, or an effusion. This is a right pleural effusion (in a baby). Note the clear, pale yellow appearance of the fluid. This is a serous effusion.
渗出过程
• • • • 血流动力学改变 血管通透性升高 液体渗出 白细胞渗出及其作用
Seen here is vasodilation with exudation that has led to an outpouring of fluid with fibrin into the alveolar spaces, along with PMN's.
炎症的原因
• 致炎因子：引起组织和细胞损伤，诱发炎 症反应的因素。
– 物理性因子 – 化学性因子 – 生物性因子：感染（infection） – 坏死组织 – 变态反应或异常免疫反应 炎症的发生和炎症过程受致炎因子和机体自身状 态两方面共同影响
炎症的临床类型： • 超急性炎症：数小时至数天 • 急性炎症：数天至一个月 • 慢性炎症：数月至数年 • 亚急性炎症：一至数月
Vascular leakage induced by chemical mediators. A, This is a fixed and cleared preparation of a rat cremaster muscle examined unstained by transillumination. One hour before sacrifice, bradykinin was injected over this muscle, and colloidal carbon was given intravenously. Plasma, loaded with carbon, escaped, but most of the carbon particles were retained by the basement membrane of the leaking vessels, with the result that these became "labeled" black. Note that not all the vessels leak-only the venules. In B, a higher power, the capillary network is faintly visible in the background.
The components of acute and chronic inflammatory responses: circulating cells and proteins, cells of blood vessels, and cells and proteins of the extracellular matrix.
炎症的基本病理变化
• 变质(alteration)、渗出(exudation)和增生 (proliferation) • 早期以变质和渗出为主，后期以增生为主。 • 三者相互联系
变质（alteration）
• 炎症局部组织或细胞发生变性和坏死。 • 是致炎因子引起的损伤过程 • 常见的变质性变化：
白细胞渗出和吞噬作用
• 白细胞从血管内穿过管壁到达损伤部位的 过程称为白细胞渗出 • 炎性细胞浸润：炎症反应最重要的组织形 态学特征 • 炎症防御反应的中心环节
白细胞的游出 聚集 作用

白细胞游出的过程
• 白细胞边集 – 离开血管中心的轴流，到达血管的边 缘，沿着内皮细胞表面滚动、附壁。 • 白细胞粘着 – 依靠细胞表面的黏附分子的作用来完成。
– 细胞水肿、脂肪变性、细胞凝固性坏死或液化 性坏死 – 粘液变性和纤维素性坏死
增生（proliferation）
• 炎症局部组织内的细胞增生或再生，使细胞数目 增多。 • 实质细胞的增生（上皮、腺体等） • 间质细胞的增生（巨噬细胞、成纤维细胞、血管 内皮细胞）
渗出（exudation）
• 炎症局部组织血管内的液体、蛋白质和细胞成 分，通过血管壁进入组织、体腔、体表和粘膜表 面的过程。 • 是炎症最具特征性的变化 • 渗出液(exudate)和漏出液(transudate)的区别 • 在炎症早期或急性炎症时表现特别明显
全身反应：
发热 末梢血白细胞计数、类型的变化 核左移
Here is simple edema, or fluid collection within tissues. This is "pitting" edema because, on physical examination, you can press your finger into the skin and soft tissue and leave a depression.