病理学呼吸系统.ppt

1、呼吸系统疾病呼吸系统疾病呼吸系统疾病呼吸系统疾病 The Respiratory SystemThe Respiratory System第四章快速气体交换 Rapid gas exchange FVentilationFPerfusion FDiffusion 清洁空气 肺的结构与功能 MucosaSubmucosaCartilageMusclesBronchusBronchial epithelium Kulchitsky cells Bronchial Submucosal Glands Alveoli The respiratory membrane 病原体 Pathogen F空气

2、contaminated air exposure F鼻咽部菌群鼻咽部菌群 nasopharyngeal flora aspiration宿主防御功能下降 Compromised defense mechanisms F肺部疾病肺部疾病 other common lung diseaseF免疫缺陷免疫缺陷 ImmunodeficiencyF生活方式生活方式 Life style肺部感染 Pulmonary Infections分类 Classification 根据解剖和影像学 Anatomy and radiographyAnatomy and radiography根据病因 Etiolog

3、yEtiology根据在哪获得 Setting in which they arise Setting in which they arise FCommunity-AcquiredCommunity-Acquired FHospital-acquiredHospital-acquired(nosocomial)(nosocomial)一、细菌性肺炎 大叶性肺炎 （95%肺炎链球菌）小叶性肺炎 军团菌性肺炎 （肺炎+全身毒血症状）小叶性肺炎小叶性肺炎大叶性肺炎大叶性肺炎 患者杨某，男，患者杨某，男，20岁，学生。酗酒岁，学生。酗酒后遭雨淋，于当天晚上突然起病，寒颤、后遭雨淋，于当天晚上突然起病

4、，寒颤、高热、呼吸困难、胸痛，继而咳嗽，咳高热、呼吸困难、胸痛，继而咳嗽，咳铁锈色痰，其家属急送当地医院就诊。铁锈色痰，其家属急送当地医院就诊。听诊，左肺下叶有大量湿性啰音；触诊听诊，左肺下叶有大量湿性啰音；触诊语颤增强；血常规：语颤增强；血常规：WBC：17X109/L；X线检查，左肺下叶有大片致密阴影。线检查，左肺下叶有大片致密阴影。典型病例典型病例1入院经抗生素治疗，病情好转，各种症状逐入院经抗生素治疗，病情好转，各种症状逐渐消失；渐消失；X X线检查，左肺下叶的大片致密阴影线检查，左肺下叶的大片致密阴影缩小缩小2/32/3面积。病人于入院后第面积。病人于入院后第7 7天自感无症天自感无

5、症状出院。冬季征兵体检，状出院。冬季征兵体检，X X线检查左肺下叶有线检查左肺下叶有约约3cmX2cm3cmX2cm大小不规则阴影，周围边界不清，大小不规则阴影，周围边界不清，怀疑为怀疑为“支气管肺癌支气管肺癌”。在当地医院即做左。在当地医院即做左肺下叶切除术。病理检查，肺部肿块肉眼为肺下叶切除术。病理检查，肺部肿块肉眼为红褐色肉样，镜下为肉芽组织。红褐色肉样，镜下为肉芽组织。大叶性肺炎大叶性肺炎大叶性肺炎大叶性肺炎大叶性肺炎大叶性肺炎In the era before antibiotics 充血水肿期 Hyperemia and edema红肝期 Red hepatization灰肝期 G

6、ray hepatization溶解消散期 Resolution(hopefully)Hyperemia and edema，12-24 hours Red hepatization 2-3 daysGray hepatization，3-4 days并发症 complications肺脓肿，脓胸，脓气胸败血症，脓毒败血症，感染性休克肺肉质变小叶性肺炎小叶性肺炎小叶性肺炎小叶性肺炎Filled with exudateAerated lung小叶性肺炎小叶性肺炎小叶性肺炎小叶性肺炎并发症 Complications 心力衰竭、呼吸衰竭肺脓肿、脓胸、脓毒败血症 支气管扩张Organization

7、 Abscess formation Abscess formation Purulent pleuritisHemorrhagic Pneumoniaby Pseudomonas aeruginosaPseudomonas pneumonia Klebsiella pneumonia二、病毒性肺炎/三、支原体性肺炎 轻者为急性间质性肺炎，旧称不典型性肺炎atypicalF缺乏实变体征缺乏实变体征 FWBC轻度升高轻度升高 重者为急性呼吸窘迫症ARDSF肺泡弥漫性损伤肺泡弥漫性损伤F透明膜形成透明膜形成Viral pneumoniaAtypical pneumonia Severe Acute

8、 Respiratory Syndrome(SARS)Pneumonia in the Immunocompromised Host 机会致病原 opportunistic agentsopportunistic agents常为多重感染 Fbacteriabacteria (P.aeruginosa,Mycobacterium spp.,L.pneumophila,and Listeria monocytogenes)Fvirusesviruses (cytomegalovirus and herpesvirus)Ffungifungi (P.jiroveci,Candida spp.,As

9、pergillus spp.,and Cryptococcus neoformans)CMV infections in situ hybridizationSputum cytology from an AIDS patient(Papanicolaou)(Giemsa)Pneumocystis Pneumonia(silver stain)Pneumocystis Pneumonia(silver stain)Pneumocystis Pneumonia Pneumocystis carinii in bronchial lavage from an AIDS patient(Grocot

10、ts silver)(Papanicolaou)(Immunostaining)慢性阻塞性肺病 (COPD)Chronic Obstructive Pulmonary Diseaselimitation of airflow usually resulting from an increase in resistance caused by partial or complete obstruction at any levelF肺气肿肺气肿 EmphysemaF慢性支气管炎慢性支气管炎 Chronic bronchitisF支气管扩张支气管扩张 BronchiectasisF哮喘哮喘 Ast

11、hmaFEV1/FVCClinical TermClinical TermAnatomic SiteAnatomic SiteMajor Pathologic Major Pathologic ChangesChangesEtiologyEtiologySignsSigns/Symptoms/SymptomsChronic Chronic bronchitisbronchitisBronchusBronchusBronchioleBronchioleMucus gland Mucus gland hyperplasia,hyperplasia,hypersecretionhypersecret

12、ionInflammatory Inflammatory scarringscarringTobacco Tobacco smoke,air smoke,air pollutantspollutantsCough,Cough,sputum sputum productionproductionCough,Cough,dyspneadyspneaBronchi-Bronchi-ectasisectasisBronchusBronchusAirway dilation and Airway dilation and scarringscarringPersistent or Persistent

13、or severe severe infectionsinfectionsCough,Cough,purulent purulent sputum,sputum,feverfeverAsthmaAsthmaBronchusBronchusSmooth muscle Smooth muscle hyperplasia,hyperplasia,excessive mucus,excessive mucus,inflammationinflammationImmunologic Immunologic or undefined or undefined causescausesEpisodic Ep

14、isodic wheezing,wheezing,cough,cough,dyspneadyspneaEmphysemaEmphysemaAcinusAcinusAirspace Airspace enlargement,enlargement,wall destructionwall destructionTobacco Tobacco smokesmokeDyspneaDyspnea 我国国家“十五”课题最新统计数据（2005年公布）显示40岁以上人口COPD患病率为8%。估计全国有2500万人罹患此病，每年因COPD死亡的人数达100万，致残人数达5001000万，COPD居我国疾病负担

15、的首位。慢性支气管炎 Chronic bronchitisA persistent cough productive of sputum for at least 3 months,in at least 2 consecutive yearsF单纯型单纯型 Simple F喘息型喘息型 Asthmatic F阻塞型阻塞型 obstructive 病 因 etiology吸烟和空气污染 Cigarette smoking and air pollutants感染 Microbial infection FSecondary roleF使炎症持续，加重症状使炎症持续，加重症状 maintaini

16、ng the inflammation and exacerbating symptoms发病机制 Pathogenesis 多痰粘液分泌亢进 Hypersecretion of mucus F大气道病变大气道病变 large bronchial involvement F粘液腺增生，杯状细胞分泌亢进粘液腺增生，杯状细胞分泌亢进 Hypertrophy of mucous glands and a marked increase in mucin-secreting goblet cells 气道阻塞 Airflow obstructionF小气道炎症和管壁纤维化小气道炎症和管壁纤维化 inflammation,bronchiolar wall fibrosis F杯状细胞化生，细支气管痰栓形成杯状细胞化生，细支气管痰栓形成 goblet cell metaplasia with mucus plugging of the bronchiolar lumenF并发肺气肿并发肺气肿 coexistent emphysema 发病机制 Pathogenesis inner perichon