病理学（Pathology）－－－研究疾病的病因，发病机制，病理变化，结局和转归的基础学科．尸体剖检（Autopsy）简称尸检。活体组织检查（Biopsy）简称活检． Pathology (Pathology) - the study of the etiology of disease, pathogenesis, pathological changes, outcome and regression of the basic disciplines. Autopsy (Autopsy) referred to as autopsy. Biopsy (Biopsy) referred to as biopsy.
第一章 细胞和组织的适应与损伤 Chapter 1: Adaptation and Damage to Cells and Tissues
适应和损伤性变化都是疾病发生的基础性病理改变。 Both adaptive and injurious changes are pathologic alterations that underlie disease development.
适应：细胞和由其构成的组织，器官对内，外环境中各种有害因子（生理负荷过多／少）和刺激作用（轻度持续）而产生的非损伤性应答反应，表现为：萎缩，肥大，增生，化生 Adaptation: the non-invasive response of cells and their constituent tissues and organs to various harmful factors (physiological overload/underload) and stimuli (mild persistence) in the internal and external environments, manifested by atrophy, hypertrophy, hyperplasia, and metaplasia.
一．肥大：实质细胞，组织和器官的体积增大。 I. Hypertrophy: an increase in the size of parenchymal cells, tissues, and organs.
机制：生长因子 uarr\uparrow ，蛋白合成 uarr\uparrow Mechanism: growth factors uarr\uparrow , protein synthesis uarr\uparrow
生理性肥大 physiological hypertrophy
e．g．运动员，体力劳动者肌肉肥大，妊娠时子宫肥大 e. g. Athletes, muscle hypertrophy in manual workers, uterine hypertrophy in pregnancy
病理性肥大 pathological hypertrophy
代偿性肥大：如高血压时的心脏。 Compensatory hypertrophy: e.g., heart in hypertension.
内分泌性肥大：生长激素分泌过多导致的肢端肥大症。后果：可复性 Endocrine hypertrophy: acromegaly due to overproduction of growth hormone. Consequences: reversible
二．增生：器官或组织实质细胞的数量增多。 II. Hyperplasia: an increase in the number of parenchymal cells of an organ or tissue.
增生的原因：激素：如前列腺增生。 Causes of hyperplasia: hormones: e.g. prostate enlargement.
生长因子：如再生性增生。 Growth factors: e.g., regenerative hyperplasia.
代偿：如缺碘所致的甲状腺增生。 Compensation: e.g. thyroid hyperplasia due to iodine deficiency.
后果：可复性，修复，肿瘤性增生 Consequences: reversibility, repair, tumorigenic proliferation
三．萎缩：发育正常的实质细胞，组织和器官体积缩小。其本质是该组织，器官的实质细胞体积缩小或／和数量减少。 III. Atrophy: A reduction in the size of normally developed parenchymal cells, tissues and organs. It is essentially a reduction in the size or/and number of parenchymal cells of the tissue or organ.
萎缩的组织，器官体积常均匀性缩小，重量减轻，质地硬韧，色泽加深＂小＂，＂轻＂，＂韧＂，＂深＂光镜观察：（1）实质细胞体积缩小或／和数量减少（2）萎缩细胞胞浆内常有脂褐素增多（老年斑） Atrophied tissues, organs are often uniformly reduced in size, weight, hard and tough, deepened in color "small", "light", "tough", "darker "Light microscopic observation: (1) parenchymal cell volume or / and number of reduced (2) atrophic cell cytoplasm often lipofuscin increased (age spots)
（3）间质内纤维或／和脂肪组织增生（可能产生假性肥大）蛋白质合成减少，分解增加。电镜观察：萎缩细胞的细胞器减少，自噬泡增多。 (3) Proliferation of fibrous or/and adipose tissue in the interstitium (may produce pseudohypertrophy) Decreased protein synthesis and increased catabolism. Electron microscopy: reduced organelles and increased autophagic vesicles in atrophic cells.
分类：生理性萎缩 Classification: Physiological atrophy
病理性萎缩：营养不良性萎缩，缺血性萎缩（如脑动脉硬化导致脑萎缩）。压迫性萎缩（e．g．肾孟积水）。废用性萎缩．去神经性萎缩（小儿麻痹症）。内分泌性萎缩。 Pathological atrophy: dystrophic atrophy, ischemic atrophy (e.g. cerebral atrophy due to cerebral arteriosclerosis). Compressive atrophy (e.g., hydronephrosis). Wasting atrophy. Denervation atrophy (poliomyelitis). Endocrine atrophy.
后果：可复性，细胞消失 Consequences: reproducible, cells disappear
四。化生（metaplasia）一种分化成熟的细胞因受刺激作用而转化为另一种分化成熟细胞的过程。（只发生于同源性细胞之间），只出现于具有增生能力的组织细胞中 iv. Metaplasia (metaplasia) The process by which one type of differentiated mature cell is transformed into another type of differentiated mature cell as a result of a stimulus. (occurs only between cells of the same origin) and occurs only in tissue cells with the ability to proliferate
常见类型：鳞状上皮（复层扁平上皮）化生：常见于气管，支气管（吸烟），子宫颈，食管（返流）肠上皮化生：发生于慢性胃炎的胃粘膜化生为肠上皮。 Common types: squamous epithelium (complex flat epithelium) chemotaxis: common in trachea, bronchus (smoking), uterine cervix, esophagus (reflux) intestinal epithelial chemotaxis: occurs in chronic gastritis in which the gastric mucosa chemotaxis to intestinal epithelium.
骨组织化生：多见于间叶组织，纤维组织。 Bone tissue metaplasia: mostly in mesenchymal, fibrous tissue.
意义：1．有利于强化局部抗御环境因子刺激的能力。2．常削弱原组织本身功能。3．上皮化生可癌变。 （化生是一种对机体不利的适应性反应，应尽量消除引起化生的原因．） Significance: 1. It helps to strengthen the local resistance to the stimulation of environmental factors. 2. It often weakens the function of the original tissue itself. 3. The epithelial growths may be cancerous. (Pycnosis is an unfavorable adaptive response to the organism, and the causes of pycnosis should be eliminated as much as possible.)
细胞，组织损伤的原因： Cells, causes of tissue damage:
1 缺氧：使细胞代谢紊乱（main） 2 化学物质和药物 3 物理因素 4 生物因子（如病毒） 5营养失衡：生命必需物质的缺乏或过剩 6 内分泌因素 7 免疫反应 8 遗传变异 9 衰老 10社会—心理—精神因素：致心身疾病 11 医源性因素：致医源性疾病损伤的原理（了解）：细胞膜的破坏，线粒体的损伤，活性氧类物质（AOS）的损伤，细胞浆内高游离钙的损伤，缺血缺氧的损伤，化学性损伤，遗传变异 1 Hypoxia: disrupts cellular metabolism (MAIN) 2 Chemicals and drugs 3 Physical factors 4 Biological factors (e.g., viruses) 5 Nutritional imbalance: deficiency or excess of substances essential for life 6 Endocrine factors 7 Immune response 8 Genetic variation 9 Aging 10 Socio-psycho-psychological factors: cause psychosomatic disorders 11 Medical factors: cause Principles of injury in medical diseases (understand): disruption of cell membranes, damage to mitochondria, damage to reactive oxygen species (AOS), damage to cytoplasmic high free calcium, ischemic-hypoxic damage, chemical damage, genetic variations
缺血缺氧的损伤：钠泵功能下降，细胞吸水水肿，核糖体脱落，蛋白质合成减少，脂质沉积缺血－再灌注损伤：自由基过多，炎症，补体 Ischemic-hypoxic injury: decreased sodium pump function, cellular water uptake and edema, ribosome shedding, decreased protein synthesis, lipid deposition Ischemia-reperfusion injury: excess free radicals, inflammation, complement
损伤的形式：可逆性损伤（变性）不可逆性损伤（坏死） Forms of injury: reversible injury (degeneration) irreversible injury (necrosis)
变性（degeneration）是指细胞或细胞间质受损伤后因细胞代谢障碍所致的非致死性可逆性损伤，表现为细胞内或细胞间质内出现某些异常物质或正常物质异常蓄积，通常伴有细胞功能低下。蓄积的物质可以是：（1）过量的细胞固有成分（2）外源性，内源性物质（3）色素损伤的形态学改变 Degeneration is a non-lethal, reversible injury to cells or interstitial cells caused by impaired cellular metabolism, which is characterized by an abnormal accumulation of some abnormal or normal substances within the cells or interstitial cells, usually accompanied by cellular hypofunction. The accumulated substances can be: (1) excessive cellular intrinsic components (2) exogenous and endogenous substances (3) morphological changes of pigmentation damage.
（1）细胞水肿（cellular swelling）：细胞内水分增多导致细胞体积增大，胞浆疏松，透明浅染 (1) Cellular swelling: increased intracellular water leads to increased cell volume, loose cytoplasm, and light staining.
1）主要原因：感染，中毒，缺氧 1) Main causes: infection, poisoning, hypoxia
2）原理：能量代谢障碍，导致钠钾泵功能下降，胞内 Na+\mathrm{Na}+ 浓度高，吸水肿胀 (2) Principle: impaired energy metabolism, resulting in decreased sodium-potassium pump function, high intracellular Na+\mathrm{Na}+ concentration, and water absorption and swelling.
3）好发部位：心，肝，肾实质细胞（代谢旺盛） 3) Preferred site: heart, liver, kidney parenchymal cells (high metabolism)
4）结构特征：＂浑浊肿胀＂，切面边缘外翻隆起，似沸水淡过，空泡变性，线粒体肿胀染色淡，内质网扩张，多聚核糖体脱落 (4) Structural features: "turbid swelling", cut edges are ectopically elevated, resembling boiling water fading, vacuolar degeneration, mitochondria are swollen and pale in color, endoplasmic reticulum is dilated, and polysaccharides are detached
5）后果：可复性 5) Consequences: Reproducibility
（2）脂肪变（fatty change）甘油三酯（中性脂肪）在非脂肪细胞的细胞浆内蓄积。苏丹 III 染色为红色 (2) Fatty change (accumulation of triglycerides (neutral fats) in the cytoplasm of non-fat cells. Sudan III staining is red
1）主要原因：感染，中毒，缺氧等。 1) Main causes: infection, poisoning, hypoxia, etc.
2）结构特征：＂大黄软＂，光镜见胞内有脂质，电镜看到脂质小体 2) Structural features: "rhubarb soft", intracellular lipids seen by light microscopy, lipid vesicles seen by electron microscopy
3）好发部位：肝，心，肾实质细胞。 (3) Preferred sites: liver, heart, kidney parenchymal cells.
例：脂肪变的黄色条纹与未脂变的暗红色心肌相间，形似虎皮斑纹，称为虎斑心。 Example: The yellow streaks of fatty degeneration are interspersed with the dark red myocardium of unfatty degeneration, resembling tiger skin markings, and are called tiger heart.
脂肪肝的发生：营养不良导致载脂蛋白下降，脂肪摄入过量，脂肪酸氧化受阻（如摄入酒精） Development of fatty liver: decreased apolipoproteins due to malnutrition, excessive fat intake, impaired fatty acid oxidation (e.g., alcohol intake)
肾小管上皮细胞脂肪变：肾小管上皮细胞重吸收脂蛋白增多 Renal tubular epithelial cell steatosis: increased lipoprotein reabsorption by renal tubular epithelial cells
泡沫细胞：巨噬细胞吞噬了大量被破坏细胞释放的脂质而形成 Foam cells: formed when macrophages phagocytose large amounts of lipids released by destroyed cells
（3）玻璃样变（hyaline change）：也称透明变／透明变性，指细胞内，纤维结缔组织和血管壁等处出现均质，红染，毛玻璃样半透明的蛋白质蓄积。 (3) glassy change (hyaline change): also known as hyaline change / hyaline degeneration, refers to the intracellular, fibrous connective tissue and blood vessel walls, etc., the appearance of homogeneous, reddish-stained, hairy glass-like translucent protein accumulation.
类型：细胞内玻璃样变：即细胞浆内出现异常蛋白质形成的均质红染的近圆形小体。如肾小管上皮，浆细胞（Russell 小体），肝细胞（酒精性肝炎，Mallory 小体），神经元 Type: Intracellular vitellosis: i.e., the presence of homogeneous, reddish-stained, subcircular vesicles formed by abnormal proteins in the cell plasma. Examples include renal tubular epithelium, plasma cells (Russell's vesicles), hepatocytes (alcoholic hepatitis, Mallory's vesicles), and neurons.
纤维结缔组织玻璃样变：胶原纤维老化的表现。 Fibrous connective tissue vitellosis: a manifestation of collagen fiber aging.
细动脉壁玻璃样变 A．常见于缓进性高血压（良性高血压）和糖尿病患者 B．玻璃样变动脉壁均质红染，增厚，管腔狭窄。 Vitrified artery wall A. Common in patients with slowly progressive hypertension (benign hypertension) and diabetes mellitus B. Vitrified artery wall is homogeneously reddish-stained, thickened, and lumen narrowed.
（4）淀粉样变（amyloidosis）细胞外间质内蛋白质—粘多糖复合物沉积。HE 染色呈淡红色均质状，云雾状，遇碘呈赤褐色，同淀粉，刚果红染色呈橘红色 (4) amyloidosis (amyloidosis) deposition of protein-mucopolysaccharide complexes in the extracellular mesenchyme. HE staining is reddish homogeneous, cloudy, russet when exposed to iodine, the same as amylose, and Congo red staining is orange.
实例：原发性——多发性骨髓瘤，慢性炎症，继发性——AD，甲状腺髓样癌组织，2型糖尿病的胰岛 Examples: primary - multiple myeloma, chronic inflammation, secondary - AD, medullary thyroid cancer tissue, pancreatic islets in type 2 diabetes mellitus
（5）粘液样变（mucoid degeneration）间质内粘多糖和蛋白质的蓄积。常见于间叶组织肿瘤，风湿病，动脉粥样硬化，甲状腺激素减少。在皮下组织黏液样变时脂肪组织分界不明显 (5) mucoid degeneration (mucopolysaccharide and protein accumulation in the mesenchyme. Commonly seen in mesenchymal tumors, rheumatic diseases, atherosclerosis, thyroid hormone reduction. In the subcutaneous tissue mucoid degeneration of adipose tissue demarcation is not obvious.
（6）病理性色素沉着：有色物质在细胞内，外的异常蓄积。 (6) Pathological hyperpigmentation: abnormal accumulation of colored substances inside and outside cells.
包括：含铁血黄素（产自血红蛋白代谢衍生物，由于毛细血管破裂出血或发生溶血现象时，红细胞被巨噬细胞吞噬，以含铁血黄素的方式沉积） Includes: ferric hemoflavin (from metabolic derivatives of hemoglobin, deposited as ferric hemoflavin by macrophages as a result of phagocytosis of erythrocytes in the event of bleeding from ruptured capillaries or hemolysis).
脂褐素（老年斑） Lipofuscin (age spots)
黑色素（恶性黑色素瘤，凶险） Melanin (malignant melanoma, aggressive)
胆红素（黄疸） Bilirubin (jaundice)
（7）病理性钙化：软组织内（即除骨组织和牙齿以外的组织）固体性钙盐的异常蓄积。光镜下 HE 染色为蓝色细颗粒聚集。 (7) Pathological calcification: Abnormal accumulation of solid calcium salts in soft tissues (i.e., tissues other than bone and teeth). Light microscopic HE staining shows aggregates of fine blue particles.
（1）营养不良性钙化：继发于局部坏死或即将坏死的组织或异物的异常钙盐沉积。体内钙，磷代谢 (1) Dystrophic calcification: Abnormal calcium salt deposition secondary to localized necrosis or impending necrosis of tissue or foreign bodies. Body calcium, phosphorus metabolism
正常。（结核，脂肪坏死，斑块，瘢痕，血栓） Normal. (tuberculosis, fat necrosis, plaque, scarring, thrombosis)
（2）转移性钙化：由于全身钙，磷代谢障碍所致正常组织内的多发性钙化。 (2) Metastatic calcification: multiple calcifications in normal tissues due to systemic calcium and phosphorus metabolism disorders.
发生于细胞内的变性：细胞水肿，脂肪变性，玻璃样变性，病理性钙化，病理性色素沉着 Degeneration occurring within cells: cellular edema, lipoatrophy, vitreous degeneration, pathologic calcification, pathologic hyperpigmentation
发生于细胞外的变性：玻璃样变性，病理性钙化，病理性色素沉着 Degeneration occurring outside the cell: vitreous degeneration, pathologic calcification, pathologic hyperpigmentation
细胞死亡：细胞因受严重损伤而累及胞核时，呈现代谢停止，结构破坏和功能丧失等不可逆性变 Cell death: When cells are severely damaged and the nucleus is involved, they show irreversible changes such as metabolic arrest, structural damage and loss of function.
化。 分为：坏死和调亡 Chemistry. Divided into: necrosis and tonization
坏死（necrosis）活体内局部细胞的死亡。死亡细胞代谢停止，功能丧失，结构自溶，并引发炎症反应，是不可逆性变性。 Necrosis (necrosis) Localized cell death in the living body. Dead cells are irreversibly degenerated by metabolic arrest, loss of function, structural autolysis, and triggering an inflammatory response.
基本病变：（1）核固缩，碎裂，溶解（ghost cell）（2）胞膜破裂，细胞解体，消失（3）间质胶原肿胀，崩解，液化，基质解聚（4）坏死灶周围有炎症反应。 Basic lesions: (1) nuclear consolidation, fragmentation, and lysis (ghost cell) (2) rupture of the cell membrane, cell disintegration, and disappearance (3) swelling, disintegration, liquefaction, and matrix depolymerization of interstitial collagen (4) inflammatory reaction around the necrotic foci.
凝固性坏死：A．常见于心，肾，脾，肝等器官 B．多因缺血引起 C．肉眼观为与周围分界清楚 D．光镜观为细胞结构消失，外形和组织轮廓可辨 E．其发生可能系坏死局部酸中毒致结构蛋白和酶蛋白变性，封闭蛋白质溶解过程之故。 Coagulative necrosis: A. Commonly found in the heart, kidney, spleen, liver and other organs B. Mostly caused by ischemia C. Clearly demarcated from the surrounding area with the naked eye D. Light microscopic view of the disappearance of cellular structure, the shape and outline of the tissue can be discerned E. The occurrence of this may be due to the necrosis of the local acidosis caused by the structural proteins and enzyme proteins to denature, closed the process of proteolysis.
干酪样坏死（caseous necrosis），特殊的凝固性坏死 A．是结核病的特征性病变 B．肉眼观似奶酪或豆渣 C．光镜观细胞和组织结构均崩解破坏，消失，呈现无定形，颗粒状的红染物。 Caseous necrosis, special coagulative necrosis A. is a characteristic lesion of tuberculosis B. looks like cheese or bean curd to the naked eye C. light microscopy shows disintegration and destruction of cellular and tissue structures, disappearance of amorphous, granular, reddish-stained material.
液化性坏死：A．坏死组织呈液态；B．好发于蛋白质少，脂质多，蛋白酶多，水，磷脂多的病灶，如脑，胰腺 C．原因：化脓菌感染，嗜中性粒细胞渗出，释放水解酶，组织水解成脓肿脂肪坏死：A．酶解性：见于急性胰腺炎，形成钙皀。 B．创伤性：好发于皮下脂肪组织。 Liquefactive necrosis: A. Necrotic tissue is liquid; B. Prevalent in lesions with little protein, more lipids, proteases, water, and phospholipids, e.g., brain, pancreas C. Causes: Septic bacterial infections, neutrophilic exudation, release of hydrolases, and hydrolysis of the tissue into an abscess Fatty necrosis: A. Enzymatically resolvable: seen in acute pancreatitis, with formation of a calcareous fibres. B. Traumatic: occurs in subcutaneous adipose tissue.
纤维素样坏死：A．结缔组织和血管壁内出现细丝状，小块状或环状红染的纤维素样物。 Fibrinoid necrosis: A. The presence of filamentous, small, or ring-shaped reddish-stained fibrinoid material within connective tissue and vessel walls.
B．是结缔组织病和急进性高血压的特征性病变。 C．多系崩解的胶原纤维，免疫球蛋白或免疫复合物及纤维蛋白的混合物。 B. It is a characteristic lesion of connective tissue disease and acute hypertension. C. It is mostly a mixture of disintegrating collagen fibers, immunoglobulins or immune complexes, and fibrin.
坏疽（gangrene）身体与外界相通部位的较大范围坏死合并腐败菌感染（黑＋臭）。分类：分为干性，湿性，气性三种，其比较如下。 Gangrene (gangrene) A large-scale necrosis of the part of the body connected to the outside world combined with a putrefactive bacterial infection (black + smelly). Classification: There are three types: dry, wet, and gas, which are compared as follows.
类型 typology
好发部位 favored location
原因 rationale
病变特点 Characteristics of the lesion
全身中毒症状 systemic symptoms of poisoning
干性坏疽 gangrene
四肢（尤其下肢），体表 Extremities (especially lower extremities), body surface
A 缺血，V通畅（缺血性坏死） A Ischemia, V patency (ischemic necrosis)
干缩，黑褐色分界清楚 Dryness, dark brown well demarcated
轻或无 Light or no
湿性坏疽 wet gangrene
与体表相通的内脏，如肺．肠．子宫．胆囊 Internal organs that are connected to the surface of the body, such as the lungs. Intestines. Uterus． gallbladder
A，V 均阻塞 A, V are blocked
湿润，肿胀，黑褐或边缘分界不清楚 Moist, swollen, dark brown or poorly demarcated margins
重，明显 Heavy, obviously
气性坏疽 gas gangrene
深部肌组织－凝固性坏死 Deep muscle tissue - coagulative necrosis
创伤伴厌氧产气英膜杆梭状芽孢杆菌感染 Trauma with anaerobic gas-producing Clostridium perfringens infection
肿胀，污秽，蜂窝状，捻发音分界不清 Swelling, smudging, honeycombing, poorly demarcated by twisting and pronation
结局： 1 溶解吸收：小灶性坏死经酶解液化被淋巴管，血管吸收或被吞噬细胞吞噬。2分离，排出：形成缺损（溃疡与空洞） 3\mathbf{3} 机化（organization）：坏死组织或其它异物被肉芽组织取代，逐渐纤维化的过程。 4 包裹（encapsulation）与钙化：指仅发生较大范围坏死和异物周边的机化过程。 Endings: 1 dissolution and absorption: small foci of necrosis are enzymatically liquefied and absorbed by lymphatic vessels, blood vessels, or phagocytosed.2 separation, drainage: formation of defects (ulcers and cavities) 3\mathbf{3} Mechanization: the process by which necrotic tissue or other foreign bodies are replaced by granulation tissue and progressively fibrotic. 4 encapsulation (encapsulation) and calcification: refers to the process of mechanization that occurs only in the larger periphery of necrosis and foreign bodies.
凋亡（apoptosis）是指活体内单个细胞或小团细胞的死亡。死亡细胞的质膜不破裂，不引发死亡细胞自溶，不引发急性炎症反应。 Apoptosis (apoptosis) is the death of a single cell or a small group of cells in the living body. The plasma membrane of dead cells does not rupture, does not trigger autolysis of dead cells, and does not trigger an acute inflammatory response.
1）发生机制：与基因调节有关，也称为程序性细胞死亡 1) Mechanism of occurrence: related to gene regulation, also known as programmed cell death
2）形态特点：（1）细胞固缩。（2）染色质凝聚，DNA 分解为 180－200bp 的条段。（3）胞浆芽突及凋亡小体形成。（4）巨噬细胞吞噬凋亡小体。 (2) Morphological characteristics: (1) cell shrinkage. (2) Chromatin condensation, DNA decomposition into 180-200bp segments. (3) Cytoplasmic budding and apoptotic vesicle formation. (4) Macrophages phagocytose apoptotic vesicles.
3）生理意义：维持正常器官的大小和功能，参与器官发育和改建，但凋亡不足引起恶性肿瘤，病毒感染可以引起过度凋亡（如 HIV 使得 T cell 过度凋亡） 3) Physiological significance: maintain normal organ size and function, participate in organ development and remodeling, but insufficient apoptosis causes malignant tumors, viral infections can cause excessive apoptosis (e.g., HIV causes excessive apoptosis of T cells)
凋亡与坏死的区别：核，质，膜，炎症反应，基因调控，发生条件，生化改变（坏死的细胞器肿胀，调亡的致密，膜完整） Difference between apoptosis and necrosis: nuclear, plasma, membrane, inflammatory response, gene regulation, conditions of occurrence, biochemical alterations (necrotic organelles are swollen, tonic ones are dense, membrane is intact)
第二章 损伤的修复 Chapter II. Repair of Injuries
损伤的修复：损伤造成机体部分细胞和组织丧失后，机体对所形成的缺损进行修补恢复的过程若能完全恢复原组织的功能，则称为完全再生 Repair of damage: After the loss of part of the body's cells and tissues due to damage, the process of repairing and restoring the defects formed by the body is called complete regeneration if it can completely restore the function of the original tissue
修复的形式： Forms of restoration:
再生（regeneration）：由损伤周围的同种细胞来修复，包括生理性再生，病理性再生 Regeneration: repair by the same kind of cells around the damage, including physiological regeneration, pathological regeneration
如果完全恢复原组织的功能，则为完全再生 Regeneration is complete if it fully restores the function of the original tissue
纤维性修复：由纤维结缔组织来修复 Fibrous repair: by fibrous connective tissue
再生：按再生能力的强弱： 1 ．不稳定细胞（持续分裂细胞）：具有很强的再生能力，如表皮，呼吸道，消化道粘膜上皮，淋巴及造血细胞，间皮细胞，骨髓内细胞等。 Regeneration: According to the strength of regenerative ability: 1. Unstable cells (continuously dividing cells): strong regenerative capacity, such as epidermis, respiratory tract, digestive tract mucosal epithelium, lymphatic and hematopoietic cells, mesothelial cells, cells in the bone marrow, and so on.
2．稳定细胞：在生理情况下，这类细胞在细胞增生周期中处于静止期（G0），但受到损伤刺激时，则进入 DNA 合成前期（G1），表现出较强再生能力，如肝，胰，涎腺，内分泌腺，汗腺，皮脂腺，肾小管上皮。 2. Stable cells: Under physiological conditions, these cells are in the quiescent phase (G0) of the cell proliferation cycle, but when stimulated by injury, they enter the pre-DNA synthesis phase (G1) and show strong regenerative capacity, e.g., liver, pancreas, salivary glands, endocrine glands, sweat glands, sebaceous glands, and renal tubular epithelium.
3．永久性细胞：无再生能力或再生力极弱，如神经细胞，横纹肌细胞及心肌细胞。 3. Permanent cells: no or very weak regenerative capacity, such as nerve cells, transverse muscle cells and cardiac muscle cells.
再生的组织： Regenerated tissue:
a．被覆上皮和腺上皮：当腺体的基底膜末被破坏时，可以完全恢复，反之则难以再生，e．g．肝小叶的网状支架若坏死塌陷，则难以恢复，形成纤维结缔组织，肝硬化。 a. Covered epithelium and glandular epithelium: when the basement membrane of the glands is destroyed at the end, it can be completely restored, and vice versa, it is difficult to regenerate. e. g. The reticular scaffolding of the hepatic lobules is difficult to restore if it is necrotic and collapses, and fibrous connective tissue is formed, cirrhosis of the liver.
b．骨组织：再生能力强，骨折可完全修复 b. Bone tissue: high regenerative capacity, fractures can be fully repaired
c．血管：生芽或播种生根的方式 c. Vascularization: sprouting or rooting by seeding
d．肌组织：再生能力弱，当完全断开时，靠纤维癩痕愈合 d. Muscle tissue: weak regenerative capacity, healing by fibrous bald patches when completely disconnected
e．神经组织：中枢神经不可再生（胶质㓔痕），外周神经可以（完全）再生，是断肢再植的基础 e. Nervous tissue: central nerves are not regenerable (glial scars), peripheral nerves can be (fully) regenerated and are the basis of amputation replantation
纤维性修复 Fibrous repair
过程为：肉芽组织增生 rarr\rightarrow 溶解，吸收坏死组织及异物 rarr\rightarrow 转化成以胶原纤维为主的瘏痕组织。肉芽组织（granulation tissue）由新生薄壁的毛细血管以及增生的纤维母细胞构成，并伴有大量渗出液和炎细胞（以巨噬细胞为主），肉眼观为鲜红色，颗粒状，柔软湿润，形似鲜嫩的肉芽，＂红粒软湿＂。 The process of granulation tissue proliferation rarr\rightarrow lysis, absorption of necrotic tissue and foreign material rarr\rightarrow and transformation into collagen fiber-based scar tissue. Granulation tissue (granulation tissue) by the new thin-walled capillaries and hyperplasia of fibroblasts, with a large amount of exudate and inflammatory cells (macrophage-based), the naked eye view of bright red, granular, soft and moist, similar to the shape of the tender buds of meat, "red grains of soft and wet".
肉芽组织由三种成分构成：（1）新生的毛细血管（2）纤维母细胞（3）炎细胞。 Granulation tissue consists of three components: (1) newborn capillaries (2) fibroblasts (3) inflammatory cells.
肉芽组织的作用：（1）抗感染保护创面（2）填补创口及其它组织缺损（3）机化或包裹坏死组织，血栓及其它异物。 The role of granulation tissue: (1) anti-infection to protect the wound (2) fill the wound and other tissue defects (3) mechanization or encapsulation of necrotic tissue, thrombus and other foreign bodies.
结局：肉芽组织长出后 1 周逐渐成熟，最终转变为瘟痕组织，胶原纤维增多，纤维母细胞转为纤维细胞，此外可有少量淋巴细胞及浆细胞。 Outcome: The granulation tissue matures in 1 week and eventually transforms into plague tissue with increased collagen fibers, fibroblasts to fibroblasts, and a small number of lymphocytes and plasma cells.
縻痕（scar）组织是指肉芽组织经改建成熟形成的纤维结缔组织。由大量平行或交错分布的胶原纤维束组成。 Any tie scar (scar) tissue is the fibrous connective tissue formed by the alteration and maturation of granulation tissue. It consists of a large number of collagen fiber bundles distributed in parallel or staggered.
大体是局部呈收缩状态，原因是肉芽组织有细肌丝，有平滑肌的收缩功能，有利于创面减小对机体的影响包括两个方面： The reason for the largely localized state of contraction is that the granulation tissue has fine muscle filaments with smooth muscle contractile function, which facilitates trauma reduction The effect on the organism consists of two aspects:
1，对机体有利的一面：（1）填补并连接伤口或缺损（2）使组织器官保持其坚固性。 1, Beneficial to the organism: (1) Filling and connecting wounds or defects (2) Keeping tissues and organs in their firmness.
2，对机体不利的一面：（1）瘡痕收缩，引起器官活动受限或梗阻（2）痸痕性粘连，器官内广泛损伤导致广泛纤维化玻璃样变，可引起器官硬化（3）瘏痕组织增生过度（瘷痕体质），可形成瘢痕疮㾑。创伤愈合：是指机体遭受外力作用，皮肤等组织出现离断或缺损后的愈合过程，包括组织再生，肉芽组织增生和曒痕形成。 2, the adverse side of the body: (1) scar contraction, causing organ activity restriction or obstruction (2) scar adhesions, extensive damage in the organ leading to extensive fibrosis vitreous lesions, can cause organ sclerosis (3) excessive proliferation of scar tissue (scarred body), can form keloid sores ����������. Trauma healing: refers to the healing process after the body is subjected to external forces and the skin and other tissues become severed or defective, including tissue regeneration, granulation tissue proliferation and scar formation.
（一）皮肤创伤愈合的基本过程： (i) The basic process of skin wound healing:
1．伤口的早期变化：伤口处出现炎症反应，充血，浆液，WBC 渗出，局部红肿， 3 天后巨潄细胞出现。 1. Early changes in the wound: Inflammatory reaction in the wound, congestion, plasma, WBC exudation, localized redness and swelling, appearance of giant weezy cells after 3 days.
2．伤口收缩：伤口边缘的皮肤及皮下组织向中心移动，伤口缩小，这是由于伤口边缘处新生的肌纤维母细胞牵引作用所致。（2－3d） 2. Wound contraction: the skin and subcutaneous tissues at the wound edge move towards the center and the wound shrinks, due to the traction effect of the newborn myofibroblasts at the wound edge. (2-3d)
3．肉芽组织增生和瘢痕形成：损伤后 3 天开始出现肉芽组织，以后胶原纤维形成活跃，损伤后一个月瘢痕完全形成。 3. Granulation tissue proliferation and scar formation: granulation tissue begins to appear 3 days after the injury, then collagen fiber formation is active, and the scar is completely formed one month after the injury.
4．表皮及其他组织再生 4. Epidermal and other tissue regeneration
（2）创伤愈合的类型 (2) Types of wound healing
1．一期愈合：见于组织缺损少，创缘整齐，无感染，经粘合或缝合后创面对合严密的伤口。其特点是；愈合时间短，留下瘢痕少。 1. One-stage healing: seen in the tissue loss is small, the edge of the wound is neat, no infection, by bonding or suture after the creation of a tightly closed wound. It is characterized by short healing time and less scarring.
2．二期愈合：见于组织缺损较大，创缘不整，哆开，无法整齐对合，或伴有感染的伤口。其特点是：（1）伤口需清创（2）愈合时间长（3）形成㓔痕大。 2. Second-stage healing: seen in large tissue defects, uneven margins, do open, can not be neatly aligned, or with infection of the wound. It is characterized by: (1) the wound needs to be debrided (2) the healing time is long (3) the formation of 㓔 scar is large.
（3）影响创伤愈合的因素：年龄，营养，感染与异物，局部血液循环，神经支配，电离辐射 （二）骨折愈合的基本过程： (3) Factors affecting wound healing: age, nutrition, infection and foreign bodies, local circulation, innervation, ionizing radiation (2) Basic process of fracture healing:
1．血肿形成。 1. Hematoma formation.
2．纤维性骨痂形成：肉芽组织机化血肿，继而发生纤维化，形成纤维性骨痂，又称暂时性骨痂。 3．骨性骨疵形成。 2. Fibrous bone scab formation: granulation tissue mechanized hematoma, followed by fibrosis, the formation of fibrous bone scab, also known as temporary bone scab. 3. Bony bone defect formation.
4．骨㾐改建或再塑：改建是在破骨细胞的骨质吸收及骨母细胞新骨质形成的协调作用下完成的。骨折愈合除了需要创伤愈合的条件外，还需要断端及时正确复位，牢靠的固定，早日锻炼，恢复血供 4. Bone remodeling or remodeling: remodeling is accomplished under the coordinated action of bone resorption by osteoclasts and new bone formation by osteoblasts. In addition to the conditions of trauma healing, fracture healing also requires timely and correct repositioning of the broken end, secure immobilization, early exercise, and restoration of blood supply.
第三章 局部血液循环障碍 Chapter 3 Local circulation disorders
正常血循环的意义：保持机体内环境稳定，各器官新陈代谢和正常进行 The significance of normal blood circulation: to maintain the stability of the internal environment of the body, the metabolism of various organs and normal progress
局部性血液循环障碍表现：（1）血管内成分逸出血管外（水肿，积液，出血）（2）局部组织内循环血量的异常（充血，淤血，缺血）（3）血液内出现异常物质（血检和血管内空气，脂滴和羊水） Localized circulatory disorders: (1) escape of intravascular components from the blood vessels (edema, effusion, hemorrhage) (2) abnormalities in the amount of circulating blood in the local tissues (congestion, bruising, ischemia) (3) the presence of abnormal substances in the bloodstream (blood tests and intravascular air, lipid droplets and amniotic fluid).
一，充血（hyperemia） I. Congestion (hyperemia)
Def：器官或组织因动脉输入血量的增多而发生的充血，称为动脉性充血，简称充血。广义上说，充血是局部组织血管内血液含量增多即为充血（包括动静脉） Def: Congestion that occurs in an organ or tissue as a result of increased blood input from an artery is called arterial congestion, or simply congestion. Broadly speaking, congestion is defined as an increase in the blood content within the blood vessels of a local tissue (including arteries and veins)
特点：为主动过程，表现为局部组织或器官小动脉及毛细血管扩张，血液输入量增加。 Characteristics: An active process, manifested by dilation of small arteries and capillaries in local tissues or organs and increased blood input.
原因：神经体液因素导致舒血管神经兴奋性增高，缩血管神经兴奋性降低分类： Causes: Neurohumoral factors leading to increased excitability of the diastolic nerves and decreased excitability of the constrictor nerves Classification:
生理性充血：为适应器官和组织生理需要和代谢增强而发生的充血，称为生理性充血（进食后胃肠道粘膜充血，活动时骨骼肌充血，妊娠时子宫充血） Physiological congestion: congestion that occurs in response to the physiological needs of organs and tissues and increased metabolism is called physiological congestion (gastrointestinal mucosal congestion after eating, skeletal muscle congestion during activity, uterine congestion during pregnancy)
病理性充血：（1）炎症性充血（致炎因子使舒血管神经兴奋）（2）减压后充血（大量抽放腹水） Pathologic congestion: (1) inflammatory congestion (excitation of the vasorelaxing nerves by inflammatory factors) (2) congestion after decompression (massive evacuation of ascites)
侧支循环性充血。 Collateral circulation congestion.
病变：大体：充血的组织，器官，体积轻度增大，体表红热＂大红热旺扩＂ Lesions: gross: congested tissues, organs, mild increase in size, red heat on the surface of the body "large red heat expanding
镜下：局部细动脉及毛细血管扩张，充血 Microscopy: local dilatation of fine arteries and capillaries, congestion
结局：1．一般为短暂反应，促进局部代谢，抗炎，对机体无不良后果。2．导致血管破裂出血。 Endings: 1. Generally transient reactions, promoting local metabolism, anti-inflammatory, with no adverse consequences for the body. 2. Leads to rupture of blood vessels and hemorrhage.
二，淤血（congestion） II. Bruising (congestion)
器官或组织由于静脉回流受阻，血液淤积于毛细血管和小静脉内，称为淤血，也称静脉性充血。 Blood pooling in capillaries and small veins in organs or tissues as a result of obstruction of venous return is called bruising, or venous congestion.
特点：为被动过程 分为：全身性淤血 局部性淤血 Characteristics: passive process Divided into: generalized bruising localized bruising
淤血发生的原因： Reasons for the occurrence of bruising:
1．静脉受压：静脉受压其管腔变狭窄或闭塞，血液回流受阻而致。 1. Venous compression: venous compression narrows or occludes the lumen of the vein and impedes the return of blood.
2．静脉腔阻塞：血栓形成或肿瘤细胞瘤栓可阻塞静脉而引起淤血。 2. Venous lumen obstruction: thrombosis or tumor cell tumor embolus can block the vein and cause bruising.
3．心力衰竭：心脏不能排出正常容量的血液进入动脉，心腔内血液滞留，压力增高，阻碍了静脉的回流，造成淤血。 3. Heart failure: the heart is unable to discharge the normal volume of blood into the arteries, blood stagnation in the heart chambers, increased pressure, impeding the return of the veins, resulting in stagnation.
4．深静脉瓣膜功能不全 4. Deep vein valve insufficiency
病变： Lesions:
大体：器官肿胀，呈暗紫红色（还原血红蛋白增加），出现发绀，淤血性水肿，浆膜腔积液，淤血性出血 Gross: organs are swollen and dark purplish red (increased reduced hemoglobin), cyanosis, bruised edema, fluid in the plasma cavities, bruised hemorrhage
镜下：局部毛细血管扩张，过多的红细胞积聚。含铁血黄素细胞－吞噬血红蛋白的巨噬细胞 Microscopy: localized capillary dilatation and accumulation of excess red blood cells. Iron-containing hemosiderin cells-macrophages that phagocytose hemoglobin
结局：取定于器官／组织的性质，淤血的程度，淤血时间长短。 1．短时间淤血：后果轻微，诱因去除后可恢复正常。2．长时间淤血：发生变性，萎缩，甚至坏死。肝和肺的慢性淤血，导致组织内网状纤维胶原化和纤维组织增生，因而质地逐渐变硬，造成淤血性硬化。 Outcome: Depends on the nature of the organ/tissue, the degree of bruising, and the duration of the bruising. 1. Short-term bruising: minor consequences, return to normal after removal of the causative agent. 2. Prolonged bruising: degeneration, atrophy, or even necrosis. Chronic bruising of the liver and lungs leads to collagenization of reticular fibers and proliferation of fibrous tissue in the tissues, and thus the texture gradually hardens, resulting in bruising sclerosis.
体循环淤血及重要器官的淤血 Bruising of the circulation and vital organs
1．肺淤血（1）病因：左心衰导致肺静脉回流受阻。 1. Pulmonary stasis (1) Etiology: Left heart failure leading to obstruction of pulmonary venous return.
（2）病理改变：（1）大体：肺体积增大，暗红色，切面流出泡沫状红色血腥液体；慢性肺淤血，肺质地硬，棕褐色，称为肺褐色硬化。（2）镜下：急性：肺泡壁毛细血管扩张充血，肺泡间隔水肿，肺泡腔充满水肿液及出血。慢性：肺泡壁毛细血管扩张充血，肺泡壁变厚及纤维化，肺泡腔充满水肿液，出血，并见心衰细胞（heart failure cells）：含有含铁血黄素颗粒的巨噬细胞。 (2) Pathological changes: (1) Grossly: increased lung volume, dark red, cut surface outflow of foamy red bloody fluid; chronic pulmonary siltation, the lung texture is hard, brown, known as pulmonary brown sclerosis. (2) Microscopic: acute: alveolar wall capillary dilatation and congestion, alveolar septum edema, alveolar cavity filled with edema fluid and hemorrhage. Chronic: alveolar wall capillary dilatation and congestion, alveolar wall thickening and fibrosis, alveolar cavity filled with edema fluid, hemorrhage, and see heart failure cells (heart failure cells): macrophages containing ferritin-containing particles.
（3）临床体症：患者气促，缺氧，发绀，咳粉红色泡沫痰。 (3) Clinical signs: the patient was short of breath, hypoxic, cyanotic, and coughed up pink foamy sputum.
2．肝淤血 病因：右心衰导致。 2. Hepatic stasis Etiology: caused by right heart failure.
病理改变：①大体：急性：体积增大，暗红色。 慢性：槟榔肝（nutmeg liver）淤血性肝硬化 Pathologic changes: ① Gross: acute: increased size, dark red. Chronic: betel nut liver (nutmeg liver) silty cirrhosis
（2）镜下：急性期：中央静脉及肝窦出现扩张淤血，严重时肝小叶中央区发生出血和坏死，小叶外周带细胞出现脂肪样变性。 (2) Microscopic: acute stage: central vein and hepatic sinusoids appear dilated and stagnant; in severe cases, hemorrhage and necrosis occur in the central area of the liver lobules, and the cells in the peripheral band of the lobules appear steatotic degeneration.
慢性：1．小叶中央区淤血严重呈暗红色，肝细胞变性，萎缩或消失，小叶外围肝细胞出现脂肪变，这种淤血和脂肪变的改变，在肝切面上构成红黄相间的网络状图纹，形似槟榔，称为槟榔肝。 Chronic: 1. The central area of the lobules is heavily bruised in dark red, the hepatocytes are degenerated, atrophied or disappeared, and the peripheral hepatocytes of the lobules appear steatotic; this bruising and steatotic change constitutes a red and yellow network pattern on the liver section, which resembles a betel nut, and it is called betel nut liver.
2．肝细胞萎缩，坏死，网状纤维网架塌陷继而胶原化，窦周细胞（又称贮脂细胞）增生并转化成肌纤维母细胞，合成胶原纤维，最终肝脏变硬－淤血性肝硬化，也称心源性肝硬化。 2. Hepatocyte atrophy, necrosis, reticulofibrillar network collapse followed by collagenization, perisinusoidal cells (also known as lipid storage cells) proliferation and transformation into myofibroblasts, synthesis of collagen fibers, and ultimately liver hardening-silent cirrhosis, also known as cardiogenic cirrhosis.
肝门静脉受阻，将引起脾淤血，血吸虫病也会引起肝脾肿大 Obstruction of the hepatic portal vein will cause splenic stasis, and schistosomiasis will also cause hepatosplenomegaly
淤血的结局：水肿出血，萎缩变性坏死硬变，侧支循环的开放，纤维组织增生，网状组织胶原化，淤血性硬化 Outcome of bruising: edema and hemorrhage, atrophic degeneration and necrotic sclerosis, opening of collateral circulation, fibrous tissue proliferation, collagenization of reticular tissue, bruising sclerosis
三，出血：血液从血管或心腔中逸出。分类：内出血（组织间隙，体腔），外出血（体外） Third, hemorrhage: the escape of blood from a blood vessel or heart chamber. Classification: internal bleeding (tissue spaces, body cavities), external bleeding (outside the body)
按出血机制分类：破裂性出血 漏出性出血 Classification by bleeding mechanism: rupture bleeding Leakage bleeding
1）生理性出血：子宫内膜周期性出血。 1) Physiologic bleeding: cyclic bleeding from the endometrium.
2）病理性出血：创伤，血管病变，出血性疾病。 2) Pathological bleeding: trauma, vascular lesions, bleeding disorders.
病理变化：A．内出血 体腔积血：心包，胸腔，腹腔，关节腔。 血肿：组织内局限性大出血，硬膜下，皮下血肿。 Pathological changes: A. Internal hemorrhage Hematochezia in body cavities: pericardial, thoracic, abdominal, and articular cavities. Hematoma: limited hemorrhage in tissues, subdural, subcutaneous hematoma.
B．外出血（血液流出体表）鼻衄，咯血，呕血，便血，尿血，淤点，紫癜，淤斑 B. External hemorrhage (blood flowing out of the body) epistaxis, hematemesis, hematemesis, vomiting blood, blood in stool, blood in urine, bruises, purpura, bruises
结局：取决于出血的类型，出血量，出血速度，出血部位。止血／血肿／休克死亡 Ending: depends on type of bleeding, amount of bleeding, rate of bleeding, site of bleeding. Hemostasis/hematoma/death from shock
四，血栓 Four. Thrombosis.
血栓形成（thrombosis）：在活体的心脏和血管内，血液发生凝固或血液中有形成分凝聚成固体质块的过程。在凝聚过程中所形成的固体质块称为血栓。（血栓是血液在流动状态下，由于血小板活化，凝血因子激活而发生。） Thrombosis: The process by which blood coagulates or formed elements of blood coalesce into a solid mass in the heart and blood vessels of a living body. The solid mass formed during coagulation is called a thrombus. (Thrombosis occurs when blood is in a state of flow due to platelet activation and activation of coagulation factors.)
血栓形成条件：心血管内皮细胞的损伤，血流状态的改变，血液凝固性增高 Conditions for thrombosis: damage to cardiovascular endothelial cells, altered blood flow status, increased blood coagulability
（一）心血管内皮细胞的损伤 (i) Damage to cardiovascular endothelial cells
损伤原因：炎症（心内膜炎），动脉粥样硬化，心肌梗死等条件下。 Causes of injury: inflammation (endocarditis), atherosclerosis, myocardial infarction, and other conditions.
内皮细胞具有：抗凝作用（主要）促凝作用 Endothelial cells are: anticoagulant (mainly) procoagulant
1．内皮细胞的抗凝作用：（1）屏障（2）抗血小板粘集（3）抗凝血酶或凝血因子（4）促进纤维蛋白溶解。 1. Anticoagulant effects of endothelial cells: (1) barrier (2) antiplatelet adhesion (3) antithrombin or coagulation factors (4) promotion of fibrinolysis.
2．内皮细胞的促凝作用：（1）激活外源凝血过程（2）辅助血小板粘附（3）抑制纤维蛋白溶解 2. Procoagulant effect of endothelial cells: (1) activation of exogenous coagulation process (2) auxiliary platelet adhesion (3) inhibition of fibrinolysis
总结：内皮细胞的作用：（1）正常情况及内皮细胞完整时，抑制血小板粘附及抗凝。（2）内皮损伤或激活时，引起局部凝血。 Summary: Role of endothelial cells: (1) Inhibit platelet adhesion and anticoagulation under normal conditions and when endothelial cells are intact. (2) Causes localized coagulation when endothelium is damaged or activated.
3．血小板的作用：（1）粘附反应 3. Role of platelets: (1) Adhesion reaction
（2）释放反应 (2) Release reaction
（3）粘集反应 (3) Adhesion reaction
（二）血流状态的改变：指血流减慢（静脉血栓的形成，e．g。心衰，久病卧床）和产生漩涡（动脉血检，血小板的沉积）等改变，有利于血检形成。 (ii) Alteration of blood flow status: refers to changes such as slowing down of blood flow (formation of venous thrombosis, e.g. heart failure, prolonged bed-riddenness) and generation of vortices (arterial blood test, deposition of platelets), which favor the formation of blood tests.
（三）血液凝固性增加：血液中血小板和凝血因子增多，或纤维蛋白溶解系统活性降低，而出现的血液的高凝状态 (iii) Increased blood coagulability: a state of hypercoagulability of the blood due to an increase in platelets and coagulation factors in the blood or a decrease in the activity of the fibrinolytic system.
以上血栓的形成条件同时存在，相互影响 The above conditions of thrombus formation coexist and interact with each other
血栓形成的过程：血栓都是从内膜表面的血小板粘集堆开始，此后的形成过程及其组成，形态和大小决定于局部血流的速度和血栓发生的部位。 The process of thrombus formation: thrombi all start from the platelet adhesion pile on the endothelial surface, and thereafter the formation process and its composition, shape and size are determined by the speed of local blood flow and the site of thrombosis.
血栓形成的过程包括以下三个阶段：（1）血管内膜损伤处，血小板粘附，沉积，与纤维蛋白多聚体一起形成小丘。（2）血小板继续沉积，血小板堆之后产生涡流，导致下一个血小板堆的形成，多个血小板堆互相连接形成血小板小梁，其间的血液凝固，形成血栓的体部（3）混合性血栓逐渐增大阻塞血管腔，血流停止，血液凝固，形成血栓的尾部。 The process of thrombosis involves the following three stages: (1) At the endothelial injury, platelets adhere, are deposited, and together with fibrin polymers, form a mound. (2) Platelets continue to be deposited, and vortices are generated after the platelet mound, leading to the formation of the next platelet mound. Multiple platelet mounds are interconnected to form platelet trabeculae, between which the blood coagulates, forming the body of the thrombus. (3) Mixed thrombus gradually increases in size to obstruct the lumen of the vessel, and the flow of blood stops, and the blood coagulates, forming the caudal part of the thrombus.
白色血栓（pale thrombus）（1）位置：血流较快的心内膜，心腔，动脉内，静脉血栓的头部。 White thrombus (pale thrombus) (1) Location: endocardium with faster blood flow, heart chambers, intra-arterial, head of venous thrombus.
（2）病理改变：（1）大体：灰白色小结节，波浪状，表面粗糙，质实，与瓣膜或血管壁紧连。 (2) Pathologic changes: (1) Gross: small grayish-white nodules, wavy, rough surface, solid, tightly attached to the valve or vessel wall.
（2）镜下：粘集的血小板形成珊瑚状小梁，其边缘粘附着一些嗜中性粒细胞，小梁间形成少量纤维蛋白网，网眼中含一些红细胞 (2) Microscope: the adherent platelets form coral-like trabeculae with some neutrophils adhering to their edges, a small amount of fibrin mesh is formed between the trabeculae, and some erythrocytes are contained in the mesh.
混合血栓（mixed thrombus）（1）位置：多见于血流缓慢的静脉，以瓣膜囊（静脉瓣近心端）或内膜损伤处为起始点。 Mixed thrombus (mixed thrombus) (1) location: most often seen in slow-flowing veins, with the valve capsule (proximal end of the venous valve) or endothelial injury as the starting point.
（2）病理改变：（1）大体：粗糙，干燥的圆柱状，与血管壁粘着，有时可辨认出灰白与褐色相间的条纹状结构。（2）镜下：分枝状，不规则血小板小梁，其表面粘附很多的白细胞。充满小梁间纤维蛋白网的红细胞构成。 (2) Pathological changes: (1) Grossly: rough, dry cylindrical, adherent to the vessel wall, sometimes recognizable as streaks of gray and brown. (2) Microscopic: branched, irregular platelet trabeculae with many leukocytes adhering to their surface. The red blood cells that fill the fibrin network between the trabeculae constitute.
红色血栓（red thrombus） Red thrombus
（1）位置：主要见于静脉，随混合血栓逐渐增大最终阻塞管腔，局部血流停止，血液发生凝固，构成静脉血栓的尾部。 (1) Location: Mainly seen in the veins, with the gradual increase of the mixed thrombus eventually blocking the lumen, the local blood flow stops, blood coagulation occurs, constituting the tail of the venous thrombus.
（2）病理改变：（1）大体：红色，故称红色血栓。新鲜时较湿润，并有一定的弹性，与血凝块无异。经一定时间后，水分被吸收而失去弹性，变得干燥易碎。（2）镜下：血凝块。 (2) Pathologic changes: (1) Gross: red, so called red thrombus. When fresh, it is more moist and has some elasticity, which is not different from blood clot. After a certain period of time, the water is absorbed and lose elasticity, become dry and fragile. (2) Microscopic: blood clot.
透明血栓（hyaline thrombus）（1）位置：见于 DIC（弥漫性血管内凝血），发生于全身微循环小血管内。 Hyaline thrombus (1) Location: seen in DIC (diffuse intravascular coagulation), which occurs in small vessels of the systemic microcirculation.
（2）病理改变：镜下可见，故又称微血栓。主要由纤维蛋白构成。 (2) Pathological changes: visible under the microscope, so also known as microthrombosis. Mainly composed of fibrin.
血栓的结局：a．软化，溶解，吸收 b．机化（肉芽组织取代血栓），再通（脱落形成栓塞）c．钙化血栓对机体的影响：（1）有利的影响 1．止血 2．防止病原体随血液扩散。 The end of thrombus: a. Softening, dissolution, absorption b. Mechanization (granulation tissue replaces thrombus), recanalization (dislodgement to form embolus) c. Calcification Effects of thrombus on the body: (1) Favorable effects 1. Hemostasis 2. Prevention of pathogens spreading with the blood.
（2）不利的影响：（1）阻塞血管：其后果决定于器官和组织内有无充分的侧支循环。（2）栓塞，梗死。 (2) Adverse effects: (1) Obstruction of vessels: the consequences of which are determined by the presence or absence of adequate collateral circulation in organs and tissues. (2) Embolism, infarction.
（3）心瓣膜变形：心瓣膜上较大的赘生物生物机化可引起的瓣膜纤维化和变形。（4）广泛性出血 (3) Heart valve deformation: valve fibrosis and deformation caused by biomechanization of larger redundant organisms on the heart valves. (4) Extensive hemorrhage
五，栓塞（embolism）：在循环血液中出现的不溶于血液的异常物质，随血流至远处阻塞血管，这种现象称为检塞。阻塞血管的异常物质称为栓子。可见：脱落的血检检子，进入血流的脂肪滴，羊水，气体及侵入血管的肿瘤细胞团（瘤栓）。 Five, embolism (embolism): in the circulating blood appear in the blood insoluble in the abnormal material, with the blood flow to the distant blockage of blood vessels, this phenomenon is called the check plug. Abnormal substances that block blood vessels are called emboli. It can be seen as: shedding of blood test testicles, fat droplets entering the bloodstream, amniotic fluid, gas and invasion of blood vessels by tumor cell clusters (tumor embolism).
一，栓子运行的途径：栓子运行的途径与血流方向一致（静脉系统栓子－肺动脉栓塞，主动脉系统栓子－阻塞器官小动脉 e．g．脑，脾，肾，门静脉系统栓子－门脉高压） I. Pathway of emboli: emboli travel in the same direction as blood flow (venous system emboli - pulmonary embolism, aortic system emboli - obstruction of small arteries in organs e.g. brain, spleen, kidneys, portal vein system emboli - portal hypertension)
特异：1，交叉性栓塞：又称反常性栓塞（静脉的栓子流入动脉），发生于房间隔或室间隔缺损者。 2．逆行性栓塞：罕见于下腔静脉血栓（胸腹压突然升高）。 Specific: 1. Cross embolism: also known as paradoxical embolism (flow of emboli from veins into arteries), occurs in people with atrial septal or ventricular septal defects. 2, Retrograde embolism: rare in inferior vena cava thrombosis (sudden rise in chest and abdominal pressure).
二，栓塞的类型和对机体的影响 II. Types of embolism and effects on the organism
（一）血栓栓塞：血栓引起的栓塞称为血栓栓塞（thromboembolism），是栓塞中最为常见的一种 (a) Thromboembolism: Embolism caused by blood clots is called thromboembolism, which is the most common type of embolism.
1．肺动脉栓塞：血栓检子 95%95 \% 以上来自下肢深静脉（股，髂，腘静脉），少数为盆腔静脉，偶尔来自右心，检子较小，无症状，中等大小，肺出血，如有左心衰，则可能引起肺组织梗死，栓子较大，引起呼吸循环系统衰竭而死亡 1. Pulmonary artery embolism: thrombus detector 95%95 \% more than from the deep veins of the lower limbs (femoral, iliac, popliteal veins), a few for the pelvic veins, occasionally from the right heart, detector small, asymptomatic, medium size, pulmonary hemorrhage, if there is a left heart failure, it may cause infarction of the lung tissues, the embolus is large, causing respiratory and circulatory system failure and death
2．体循环动脉栓塞：来源：左心（赘生物，附壁血栓，占 80%80 \% ）大动脉（动脉粥样硬化和 A 瘤的附壁血栓）栓塞部位及后果：脾，肾，脑，心终末动脉－局灶梗死 下肢大 A，肠系膜 A－广泛梗死 上肢 A（吻合支丰富），肝 A（门静脉，肝动脉双供血）很少发生梗死 2. Arterial embolism in the circulation: source: left heart (redundancy, epiphyseal thrombus, accounting for 80%80 \% ) aorta (atherosclerosis and epiphyseal thrombus of A tumors) site of embolism and its consequences: spleen, kidneys, brain, cardiac arteries - focal infarcts, lower extremity A, mesenteric A - extensive infarcts, upper extremity A (anastomotic branches abundant), hepatic A (portal vein, hepatic A dual supply) infarcts rarely occur. （Upper limb A (anastomotic branch rich), liver A (dual portal vein, hepatic artery) infarction rarely occurs
（二）脂肪栓塞：循环血流中出现脂肪滴阻塞小血管，称为脂肪检塞。见于长骨骨折，重脂肪组织挫伤或脂肪肝挤压伤，急性胰腺炎时，脂滴被挤压入静脉进入血液循环引起脂肪栓塞。 (ii) Fat embolism: The presence of fat droplets in the circulating blood stream obstructing small blood vessels is called fat embolism. It is seen in long bone fracture, heavy adipose tissue contusion or fatty liver crush injury, and acute pancreatitis when fat droplets are squeezed into the vein and enter the circulation causing fat embolism.
（三）气体栓塞（gas embolism）：血由大量空气迅速进入血循环或溶解于液内的气体迅速游离形成 (C) gas embolism: blood is formed by the rapid entry of large quantities of air into the blood circulation or the rapid freeing of gases dissolved in the fluid.
气泡，阻塞血管所引起的栓塞。 1．空气检塞 2．减压病（又称沉箱病，潜水员病）： N_(2)\mathbf{N}_{2} An embolism caused by an air bubble that blocks a blood vessel. 1. air embolism 2. decompression sickness (also known as caisson disease, diver's disease): N_(2)\mathbf{N}_{2}
（四）羊水栓塞：在分娩过程中子宫的强烈收缩，尤其是在羊膜破裂又逢胎儿头阻塞阴道口时，可能会将羊水压入破裂的子宫壁静脉窦内，并进入肺循环，造成羊水检塞。后果：变态反应性休克（过敏），DIC，肺动脉栓塞 (iv) Amniotic fluid embolism: Strong uterine contractions during labor, especially when the amniotic membranes rupture and the fetal head obstructs the vaginal opening, may press amniotic fluid into the ruptured venous sinuses of the uterine wall and into the pulmonary circulation, resulting in an amniotic fluid embolism. Consequences: anaphylactic shock (allergy), DIC, pulmonary embolism.
栓塞对机体的影响取决于：a．栓子大小，数量 b．部位：局部——梗死全身——相应器官功能障碍，栓子性质 c ．能否建立有效的侧支循环 The effect of embolism on the organism depends on: a. Embolus size, number b. Site: localized - infarction systemic - corresponding organ dysfunction, nature of embolus c. The ability to establish effective collateral circulation
六，梗死（infarction）：器官或局部组织由于血管阻塞，血流停滞，导致缺氧而发生的坏死，称为梗死。动脉阻塞引起的梗死较多见，静脉回流中断或静脉和动脉先后受阻亦可引起梗死。 Sixth, infarction (infarction): organs or local tissues due to vascular obstruction, blood flow stagnation, resulting in hypoxia and necrosis, known as infarction. Infarction caused by arterial obstruction is more common, venous reflux interruption or venous and arterial successive obstruction can also cause infarction.
（任何引起血管管腔阻塞，导致局部组织血液循环中止和缺血的原因均可引起梗死。） (Infarction can be caused by any cause of obstruction of the lumen of a blood vessel that results in the suspension of blood circulation and ischemia in local tissues.)
（一）梗死形成的原因： (i) Causes of infarct formation:
1．血栓形成 1. Thrombosis
2．动脉栓塞 2. Arterial embolization
3．动脉痉挛 3. Arterial spasm
4．血管受压闭塞 4. Vascular compression occlusion
（二）梗死形成的条件 1．供血血管：（1）血液和心血管系统功能状态。（2）侧支循环较差的，易发生梗死，如脾，肾，心，脑。2．局部组织对缺血的敏感程度 (ii) Conditions of infarction formation 1. Blood supply vessels: (1) The functional status of blood and cardiovascular system. (2) Poor collateral circulation, prone to infarction, such as spleen, kidney, heart, brain. 2. Sensitivity of local tissues to ischemia
梗死的形态特征：（了解） Morphologic features of infarction: (understand)
1．梗死灶的形态 取决于该器官的血管分布方式 1. The morphology of the infarct depends on the vascularization of the organ.
（1）锥体形，切面上呈三角形，如脾，肾，肺等。（2）不规则地图状，如心梗。（3）节段，如肠梗死。 (1) Cone-shaped, triangular in section, e.g., spleen, kidneys, lungs. (2) Irregularly map-shaped, e.g., cardiac infarction. (3) Segmental, as in intestinal infarction.
2．梗死灶的质地 取决于坏死的类型。 2. The texture of the infarct depends on the type of necrosis.
（1）脾，肾，心的凝固性坏死，早期局部肿胀，晚期坏死组织较干燥，质地坚实。（2）脑液化性坏死。 (1) Coagulative necrosis of the spleen, kidneys, and heart, with localized swelling in the early stages and drier, firmer necrotic tissue in the later stages. (2) Liquefying necrosis of the brain.
3．梗死灶的颜色 取决于梗死灶的含血量 3. The color of the infarct depends on the blood content of the infarct.
(1)血量少时, 贫血性梗死或白色梗死 (2)血量多时, 出血性梗死或红色梗死 (1) In low blood volume, anemic or white infarction (2) In high blood volume, hemorrhagic or red infarction
梗死的类型：（根据梗死灶含血量的多少，有无细菌感染进行分类） Type of infarction: (categorized according to the amount of blood contained in the infarct focus and the presence or absence of bacterial infection)
1．贫血性梗死：见于组织结构比较致密和侧支血管细而少的器官。 1. Anemic infarction: seen in organs with dense tissue structure and fine and few collateral vessels.
特点：（1）常发生于结构致密，血管吻合枝不丰富的组织，动脉阻塞，出血很少。（2）多见于心，肾 （注意，包膜完好），脾（包膜亦梗死），脑（液化性坏死）。 Characteristics: (1) Often occurs in dense structure, vascular anastomosis branch is not rich in tissue, arterial obstruction, bleeding is rare. (2) Most common in heart, kidney (note that the pericardium is intact), spleen (pericardium is also infarcted), brain (liquefying necrosis).
（3）病理改变：（1）大体：圆雉形或不规形，黄白色，边缘有白细胞浸润带和充血出血带。 (3) Pathological changes: (1) Gross: round pheasant-shaped or irregular, yellowish-white, bordered by bands of leukocyte infiltration and congested hemorrhagic bands.
（2）镜下：凝固性坏死，原有轮廓隐约可见，后期细胞崩解，肉芽和㾊痕形成。液化性坏死，可形成空洞，脑坏死灶可形成胶质疤痕。 (2) Microscopy: coagulative necrosis, original outline faintly visible, late cell disintegration, granulation and 㾊 scar formation. Liquefying necrosis, cavities may form, and glial scars may form in foci of brain necrosis.
2．出血性梗死（1）发生条件：（1）严重淤血伴有动脉阻塞：肺，肠，卵巢。（2）组织疏松：富有弹性，易扩展，梗死区血液不易挤出（3）具有双重血供（如肺动脉和支气管动脉） 2. Hemorrhagic infarction (1) Conditions of occurrence: (1) Severe bruising with arterial obstruction: lungs, intestines, ovaries. (2) Loose tissue: elastic, easy to expand, the infarcted area of blood is not easy to extrude (3) with a dual blood supply (such as pulmonary and bronchial arteries)
（2）病理特点：（1）大体：梗死灶，圆雉形，节段性或不规则形，暗红色，无出血充血带。 (2) Pathologic features: (1) Gross: infarct foci, round pheasant-shaped, segmental or irregular, dark red, no hemorrhagic congestive bands.
（2）镜下：梗死区组织坏死，弥漫性出血。 (2) Microscopy: tissue necrosis in the infarcted area with diffuse hemorrhage.
（3）常见的类型：（1）肺出血性梗死：常见于肺下叶外周部，尤以肋膈角处多见。 (3) Common types: (1) Pulmonary hemorrhagic infarction: common in the peripheral part of the lower lobe of the lung, especially at the angle of the rib diaphragm.
肉眼：局部隆起，暗紫色，质较实，呈锥体形，切面为楔形，尖端指向肺门或血管阻塞处，基底位于胸膜面，胸膜面常有纤维素渗出。 Naked eye: localized elevation, dark purple, solid, cone-shaped, wedge-shaped in section, tip pointing to the hilum or vascular obstruction, base located on the pleural surface, pleural surface often with fibrinous exudation.
光镜：肺泡间隔结构模糊不清，肺泡腔内和组织间隙充满红细胞，周围未坏死的肺组织多有慢性淤血及水肿 Light microscopy: the structure of alveolar septa is blurred, the alveolar lumen and tissue interstices are filled with erythrocytes, and the surrounding non-necrotic lung tissues are mostly chronically bruised and edematous
左心衰竭，在肺静脉压力增高和肺淤血的情况下，单以支气管动脉的压力，不足以克服肺静脉压力增高的阻力或栓子出现时可发生。 Left heart failure, in the presence of increased pulmonary venous pressure and pulmonary stasis, can occur when bronchial arterial pressure alone is insufficient to overcome the resistance of increased pulmonary venous pressure or when emboli are present.
（2）肠出血性梗死：常见于肠套叠，扭转和绞窄性肠疝，初时肠段肠系膜静脉受压而淤血，以后受压加剧，伴有动脉受压而使血流减少或中断，肠段缺血坏死。患者腹痛，呕吐，肠梗阻，腹膜炎。 (2) Intestinal hemorrhagic infarction: common in intussusception, torsion and strangulated intestinal hernia, the mesenteric vein of the intestinal segment is compressed and bruised at the beginning, and later the compression is aggravated, accompanied by arterial compression which reduces or interrupts the blood flow, and the intestinal segment ischemic necrosis. The patient suffers from abdominal pain, vomiting, intestinal obstruction, and peritonitis.
3．败血性梗死：由含有细菌的检子阻塞血管引起。常见：急性感染性心内膜炎。 3. Septic infarction: caused by the obstruction of blood vessels by bacterial-containing checkers. Common: acute infective endocarditis.
梗死对机体的影响和结局：取决定于梗死的器官，梗死灶的大小和部位，以及有无细菌感染等因素。梗死的结局（同坏死）1．溶解，吸收 2．机化，包裹，钙化 The effect of infarction on the organism and its outcome: depends on the organ of infarction, the size and location of the infarct, and the presence or absence of bacterial infection. The outcome of infarction (same as necrosis) 1. dissolution, absorption 2. mechanization, encapsulation, calcification
了解： Understand:
1．肾梗死：腰痛，血尿，不影响肾功能 1. Renal infarction: low back pain, hematuria, without affecting renal function
2．脾梗死：脾被膜炎 rarr\rightarrow 左上腹疼痛 2. Splenic infarction: inflammation of the splenic peritoneum rarr\rightarrow Pain in the left upper abdomen
3．肺梗死：胸痛和咯血，呼吸困难 4．肠梗死：剧烈腹痛，血便，坏疽，穿孔，腹膜炎 5．心肌梗死：导致心绞痛，动脉瘤，心脏破裂，心力衰竭，猝死 3. Pulmonary infarction: chest pain and hemoptysis, dyspnea 4. Intestinal infarction: severe abdominal pain, bloody stools, gangrene, perforation, peritonitis 5. Myocardial infarction: leading to angina pectoris, aneurysm, heart rupture, heart failure, sudden death
6．脑梗死：失语，偏痽，死亡 6. Cerebral infarction: aphasia, hemiplegia, death
7．四肢，肺，肠梗死：继发腐败菌感染 坏疽 7. Infarcts of limbs, lungs, intestines: secondary infection with putrefactive organisms Gangrene
七，水肿：指组织间隙内体液增多 VII, Edema: refers to an increase in body fluids in the interstitial spaces of tissues
水肿的发病机制：1．静脉流体静压的增高 2．血浆胶体渗透压的降低 3．淋巴液回流障碍 Pathogenesis of edema: 1. Increase in venous hydrostatic pressure 2. Decrease in plasma colloid osmolality 3. Impaired lymphatic return
4．毛细血管壁通透性增加 5．水钠潴留（重吸收的增强） 4. increased permeability of capillary walls 5. water and sodium retention (enhanced reabsorption)
水肿的病理变化： 1 ．大体：组织肿胀，颜色苍白，质软，切面可呈胶冻状。（胀白肿松） Pathologic changes of edema: 1. Gross: swollen tissue, pale in color, soft, and may be jellied in section. (Swelling white swelling loose)
2．镜下：水肿液积聚于细胞和纤维结缔组织之间或腔隙中，HE 染色为透亮空 2. Microscopy: edema fluid accumulates between cells and fibrous connective tissue or in the lumen, HE staining is translucent and empty.
白区。 细胞外基质变得疏松 White areas. The extracellular matrix becomes loose
水肿对机体的影响：部位，程度，发生速度，持续时间 Effects of edema on the body: site, degree, rate of onset, duration
第四章 炎症 Chapter 4 Inflammation
炎症：具有血管系统的活体组织对损伤因子所发生的复杂防御性反应，血管反应是炎症过程的中心环节。 Inflammation: a complex defensive response to injurious agents that occurs in living tissues with a vascular system; the vascular response is central to the inflammatory process.
一，炎症的原因（一）物理性因子（高温，低温，放射性射线）（二）化学性因子 1．外源性 2．内源性（三）生物性因子：包括各种病原微生物导致的组织损伤，是最重要的炎症原因。（四）坏死组织缺氧，代谢障碍等引起的组织损伤也是炎症的原因，如梗死灶边缘的充血出血带和炎细胞浸润。（五）变态反应或异常免疫反应 First, the causes of inflammation (a) physical factors (high temperature, low temperature, radioactive rays) (b) chemical factors 1. exogenous 2. endogenous (c) biological factors: including a variety of pathogenic microorganisms caused by tissue damage, is the most important cause of inflammation. (D) necrotic tissue hypoxia, metabolic disorders and other causes of tissue damage is also a cause of inflammation, such as infarct foci edge of the congestion hemorrhagic band and inflammatory cell infiltration. (v) Metamorphic reaction or abnormal immune response
发生炎症的关键是组织损伤，是否发生组织损伤取决于致炎因子的作用和机体本身。 The key to the occurrence of inflammation is tissue damage, the occurrence of which depends on the action of inflammatory factors and the organism itself.
二，炎症局部的基本病理变化： Second, the basic pathological changes localized in the inflammation:
变质（alteration）：炎症局部组织发生的变性和坏死称为变质。是致炎因子直接作用或由局部血液循环障碍和炎症反应产物间接引起的组织损伤。 Metamorphosis (alteration): The degeneration and necrosis that occurs in the local tissues of inflammation is called metamorphosis. It is the direct action of inflammatory factors or indirectly caused by local blood circulation and inflammatory reaction products of tissue damage.
实质细胞常出现的有细胞水肿，脂肪变性，细胞凝固性坏死或液化性坏死等。 Parenchymal cells often present with cellular edema, fatty degeneration, and cellular coagulative necrosis or liquefactive necrosis.
间质成分变质包括粘液变性和纤维素样坏死等。 Degeneration of interstitial components includes mucous degeneration and fibrinoid necrosis.
渗出（exudation）：是炎症的特征性变化，炎症局部组织血管内的液体和细胞成分，通过血管壁进入间质，体腔，粘膜表面和体表的过程称为渗出，所渗出的液体和细胞总称为渗出物和渗出液。后果：炎性水肿（渗出液积聚在组织间隙），体腔积液（渗出液积聚在浆膜腔内） Exudation (exudation): is a characteristic change of inflammation, inflammation of the local tissue vascular fluid and cellular components, through the blood vessel wall into the interstitium, the body cavity, mucosal surface and the body surface of the process is called exudation, the exuded fluid and cellular total is called exudate and exudate. Consequences: inflammatory edema (accumulation of exudate in the interstitial spaces of tissues), corpora cavernosa (accumulation of exudate in the plasma membrane lumen)
渗出的重要防御作用： The important defense role of exudation:
稀释毒素，减轻损伤； Dilute the toxins and reduce the damage;
运来营养，带走废物； Transporting nutrients and taking away waste;
补体抗体，杀菌调理； Complementary antibodies, bactericidal conditioning;
淋巴引流，诱导免疫； Lymphatic drainage to induce immunity;
渗出液过多：机化粘连，压迫阻塞（e．g．肠梗阻，肺泡积液） Excessive exudate: mechanized adhesions, compression obstruction (e.g., intestinal obstruction, alveolar effusion)
注意：渗出液和漏出液的区别 Note: Difference between exudate and leakage fluid
渗出液有较高蛋白含量，较多细胞和细胞碎片，漏出液是血浆超滤的结果 Exudate has a higher protein content, more cells and cellular debris, and leakage is the result of plasma ultrafiltration
炎症的基本过程：recognition，recruitment，removal，regulation，resolution增生（proliferation） Basic processes of inflammation: recognition, recruitment, removal, regulation, resolution proliferation (proliferation)
1．实质细胞的增生：如慢性支气管炎时粘膜上皮细胞和腺体的增生。慢性肝炎中肝细胞的增生。 1. Proliferation of parenchymal cells: for example, proliferation of mucosal epithelial cells and glands in chronic bronchitis. Proliferation of hepatocytes in chronic hepatitis.
2．间质成分的增生：包括巨噬细胞，内皮细胞和纤维母细胞（慢性纤维化）等的增生。 2. Proliferation of mesenchymal components: including macrophages, endothelial cells and fibroblasts (chronic fibrosis).
意义：炎性增生具有限制炎症扩散和损伤修复的作用。 SIGNIFICANCE: Inflammatory hyperplasia has a role in limiting the spread of inflammation and repairing damage.
小结：病变的早期以变质和渗出为主，病变的后期以增生为主。但变质，渗出和增生是相互联系的。一般说来变质是损伤性过程，而渗出和增生是对损伤的防御反应和修复过程。 Summary: Metamorphosis and exudation predominate in the early stages of the lesion, and hyperplasia in the later stages of the lesion. However, metamorphosis, exudation and hyperplasia are interrelated. Generally speaking, metamorphosis is a damaging process, whereas exudation and hyperplasia are defense responses to damage and repair processes.
三，炎症的表现 Third, manifestations of inflammation
（一）急性炎症局部的共同的临床表现：红：血管扩张，充血 肿：炎性渗出 热：局部血流增多， (a) Common localized clinical signs of acute inflammation: redness: vasodilatation, congestion Swelling: inflammatory exudation Heat: increased local blood flow.
代谢增高 痛：局部张力增高，压迫或牵拉神经末梢；炎症介质的作用 功能障碍：组织损伤；炎性水肿；疼痛 Increased metabolism Pain: increased local tension, compression or pulling of nerve endings; role of inflammatory mediators Dysfunction: tissue damage; inflammatory edema; pain
（二）炎症的全身的反应：1．发热：为一种保护性反应（IL－1，TNF 作用于体温调节中枢） (ii) Systemic responses to inflammation: 1. Fever: a protective response (IL-1, TNF act on thermoregulatory centers)
外源性：细菌毒素，病毒，立克次体等致热源 内源性：白细胞产物，前列腺素 E2 Exogenous: bacterial toxins, viruses, pyrogens such as rickettsiae Endogenous: leukocyte products, prostaglandins E2
2．白细胞增高：1）炎症介质作用下的防御反应 2）白细胞总数增高及增高的白细胞分类具有临床诊断价值 2. Increased leukocytes: 1) defense response in response to inflammatory mediators 2) increased total leukocyte count and increased leukocyte classification have clinical diagnostic value
3．急性期蛋白合成增多，单核巨噬系统增生，＂核左移＂ 3. Increased protein synthesis in the acute phase, proliferation of the mononuclear macrophage system, "nuclear left shift
四，急性炎症：反应迅速，持续时间短，常常仅几天，一般不超过一个月，以渗出性病变为主。炎症细胞主要以中性粒细胞为主。 Fourth, acute inflammation: rapid response, short duration, often only a few days, usually not more than a month, with exudative lesions. Inflammatory cells are mainly neutrophils.
1，急性炎症过程中血流动力学改变 1, Hemodynamic changes during acute inflammation
（1）细动脉短暂收缩，损伤后立即出现，持续时间短 (1) Transient constriction of fine arteries, immediately after injury, of short duration
（2）微血管扩张和血液加速（红，热的原因）（化学介质组胺，NO，缓激肽作用，也有神经作用） (2) Microvascular dilatation and blood acceleration (cause of redness, heat) (chemical mediators histamine, NO, bradykinin effect, also neurological)
（3）速度减慢（血浆外溢，血液粘度增加，红细胞浓集） (3) Slowing down (plasma spillage, increased blood viscosity, erythrocyte concentration)
2，血管通透性增加：内皮细胞收缩，内皮细胞穿胞作用增强，血管内皮细胞损伤，新生毛细血管的高通透性 2, Increased vascular permeability: endothelial cell contraction, increased endothelial cell penetration, vascular endothelial cell injury, and hyperpermeability of new capillaries
3，白细胞渗出和吞噬作用 3, Leukocyte exudation and phagocytosis
1．白细胞边集（1）定义：炎症时，白细胞离开血管中心轴流，到达血管的边缘部（边流） 1. Leukocyte marginalization (1) Definition: In inflammation, leukocytes leave the central axis of vascular flow and reach the marginal portion of the vessel (marginal flow)
2．白细胞滚动和粘着：由选择素（炎症损伤导致血管内皮细胞表达选择素水平提高）介导白细胞滚动，由内皮细胞粘附分子和白细胞表面整合素介导白细胞粘附 2. Leukocyte rolling and adhesion: leukocyte rolling mediated by selectins (inflammatory injury leading to increased levels of selectin expression by vascular endothelial cells) and leukocyte adhesion mediated by endothelial cell adhesion molecules and leukocyte surface integrins
3．白细胞游出（1）定义：白细胞通过血管壁进入周围组织的过程 3. Leukocyte efflux (1) Definition: The process by which leukocytes pass through the walls of blood vessels into the surrounding tissue.
（2）特点：游出是一种主动的阿米巴样运动（变形运动），降解血管基底膜，游出的主要部位是内皮细胞连接处。所有白细胞均可游出。 (2) Characteristics: Swimming is an active amoeboid movement (metamorphosis) that degrades the vascular basement membrane; the main site of swimming is the endothelial cell junction. All leukocytes can swim out.
急性炎症和化脓性炎症时，主要游出细胞是中性粒细胞。 In acute and suppurative inflammation, the main free cells are neutrophils.
慢性炎症，以单核，巨噬细胞和淋巴细胞，浆细胞游出为主。 Chronic inflammation, dominated by monocytes, macrophages and lymphocytes, with plasma cell excursions.
病毒感染时，以淋巴细胞，单核细胞游出为主。 In viral infections, lymphocytes are predominant, with monocytes swimming out.
过敏性炎症和寄生虫感染，以嗜酸性粒细胞游出为主。 Allergic inflammation and parasitic infections, with eosinophilic excursions predominating.
红细胞经过血管壁到达周围组织是一种被动过程，称为红细胞漏出。 The passage of erythrocytes through the vessel wall to reach the surrounding tissues is a passive process called erythrocyte leakage.
炎症早期以中性粒细胞渗出为主，后期以单核细胞浸润为主 Inflammation is characterized by neutrophilic exudation in the early stages and mononuclear cell infiltration in the later stages
（3）炎性浸润：白细胞在炎症灶内的组织间隙中弥散分布，称为炎性浸润。浸润在组织间隙中的白细胞即为炎细胞。 (3) Inflammatory infiltration: the diffuse distribution of leukocytes in the tissue interstitium within the inflammatory foci is called inflammatory infiltration. Leukocytes infiltrated in the tissue interstitial space are inflammatory cells.
4，趋化作用：白细胞向着化学刺激物的浓度梯度做移动的现象称为趋化作用。这些化学刺激物称为趋化因子，具有特异性 4, chemotaxis: the phenomenon of leukocytes moving towards the concentration gradient of chemical stimuli is called chemotaxis. These chemical stimuli are called chemokines and have specificity
5．白细胞在局部的作用 5. Local role of leukocytes
（1）吞噬作用（识别和粘着，吞入，杀灭及降解） (1) Phagocytosis (recognition and adhesion, engulfment, killing and degradation)
（2）免疫反应 (2) Immune response
（3）组织损伤作用（脱颗粒释放活性氧自由基，溶酶体酶，前列腺素等引起组织损伤） (3) Tissue-damaging effects (release of reactive oxygen radicals from degranulation, lysosomal enzymes, prostaglandins, etc. causing tissue damage)
中性粒细胞胞外诱捕网（neutrophil extracellular traps，NETs）是细胞死亡后释出的核酸和蛋白酶，呈丝网状，具有强大的杀菌作用。 Neutrophil extracellular traps (NETs) are nucleic acids and proteases released after cell death in the form of a filamentous mesh that has a powerful bactericidal effect.
白细胞功能缺陷：（1）黏附缺陷（2）吞入和脱颗粒障碍（3）杀菌活性障碍（4）骨髓白细胞生成障碍 Defects in leukocyte function: (1) defective adhesion (2) impaired engulfment and degranulation (3) impaired bactericidal activity (4) impaired bone marrow leukopoiesis
6．炎症介质：在炎症过程中由细胞释放或体液中产生的，参与或介导炎症反应的化学物质 6. Inflammatory mediators: chemicals released by cells or produced in body fluids during the inflammatory process that participate in or mediate the inflammatory response
来源（1）细胞释放的炎症介质：血管活性胺 e．g．组胺，5－羟色胺，以脱颗粒的方式作用于血管，使细动脉扩张，血管内皮细胞收缩，细静脉通透性增强；花生四烯酸代谢产物 e．g．前列腺素，白三烯，抑制花生四烯酸代谢（抑制环氧化酶）可以缓解炎症反应；白细胞产物：活性氧代谢物，溶酶体内的蛋白酶；细胞因子 e．g．IL－1，IL－8，IFN，TNF 等；血小板激活因子；NO；神经肽 e．g．P物质 Sources (1) Inflammatory mediators released by cells: vasoactive amines e.g. histamine, 5-hydroxytryptophan, act on blood vessels in a degranulation manner, causing dilation of fine arterioles, contraction of vascular endothelial cells, and increase in permeability of fine veins; arachidonic acid metabolites e.g. prostaglandins, leukotrienes, inhibition of arachidonic acid metabolism (inhibition of cyclo-oxygenases) can alleviate inflammatory response Leukocyte products: reactive oxygen metabolites, proteases in lysosomes; cytokines e.g. IL-1, IL-8, IFN, TNF, etc.; platelet-activating factor; NO; neuropeptides e.g. Substance P
（2）体液中产生的炎症介质：激肽（激肽原 rarr\rightarrow 缓激肽，血管通透性增加，引起疼痛），补体（C3a， (2) Inflammatory mediators produced in body fluids: kinins (kininogen rarr\rightarrow bradykinin, increased vascular permeability, causes pain), complement (C3a.
C5a）和凝血与纤维蛋白溶解系统三大系统。 C5a) and the coagulation and fibrinolytic systems are three major systems.
重点掌握趋化因子：C3a，C5a，IL－1，IL－8，TNF，白三烯，细菌产物 Focus on chemokines: C3a, C5a, IL-1, IL-8, TNF, leukotrienes, bacterial products
致痛：缓激肽，前列腺素 E2 Analgesic: bradykinin, prostaglandin E2
7．急性炎症的类型 7. Types of acute inflammation
大多数为渗出性炎症，但要掌握变质性炎症：乙肝，乙脑，阿米巴肠炎，增生性炎症：伤寒，肾小球肾炎 Mostly exudative inflammation, but keep track of metaplastic inflammation: hepatitis B, BSE, amoebic enteritis, proliferative inflammation: typhoid fever, glomerulonephritis
以下详述渗出性炎 The following details exudative inflammation
（一）浆液性炎：以浆液渗出为主要特征的炎症，渗出的液体成分中含 3∼5%\mathbf{3 \sim 5 \%} 的小分子蛋白质（主要是白蛋白），少量白细胞和纤维素。部位：浆膜，粘膜和疏松结缔组织等，粘膜的浆液性炎称为浆液性卡他性炎，浆膜的浆液性炎易引起积液，e．g．感冒流涕，风湿性关节炎 (I) plasmacytitis: inflammation characterized by exudation of plasma, the exudate contains 3∼5%\mathbf{3 \sim 5 \%} small molecules of protein (mainly albumin), a small number of leukocytes and cellulose. Parts: plasma membrane, mucous membrane and loose connective tissue, etc., plasmacytitis of the mucous membrane is called plasmacytocatarrhal inflammation, plasmacytosis of the plasma membrane is prone to cause fluid retention, e.g., colds and flu, rheumatoid arthritis.
一般预后良好，少部分如喉头水肿引起窒息，胸膜腔积液和心包积液影响心肺功能 The prognosis is generally good, with a few cases such as laryngeal edema causing asphyxia, pleural effusion and pericardial effusion affecting cardiopulmonary functions
（二）纤维素性炎：以纤维蛋白原渗出为主的炎症，部位：粘膜，浆膜和肺组织。 (ii) Fibrinitis: inflammation dominated by fibrinogen exudation, site: mucous membranes, plasma membranes and lung tissue.
发生于不同部位的纤维素性炎症形态不一，可表现为： Fibrinous inflammation occurring at different sites is variable in morphology and may be manifested:
①发生于黏膜的纤维素性炎称假膜性炎：（白喉）A．咽部（鳞状上皮）黏膜为固膜 B．气管（柱状纤毛上皮）黏膜为浮膜，细菌性痢疾，在肠粘膜形成伪膜 (1) Fibrinous inflammation occurring in the mucosa is called pseudomembranous inflammation: (diphtheria) A. Pharyngeal (squamous epithelium) mucosa is solid B. Tracheal (columnar ciliated epithelium) mucosa is floating Bacterial dysentery, pseudomembrane is formed in the mucosa of the intestines
（2）发生于浆膜的纤维素性炎可因运动形式不同，表现为：A．胸膜，腹膜等呈片块状 B．风湿性心外膜炎，风湿性心包炎，心包脏壁层呈＂绒毛心＂，可形成缩窄性心包炎 (2) Fibrinous inflammation of the plasma membrane can be manifested in different forms of movement, such as: A. pleura, peritoneum, etc., in the form of a sheet B. Rheumatic epicarditis, rheumatic pericarditis, pericarditis with "choroidal heart" in the dirty pericardial wall layer, which can lead to the formation of a narrowing of the pericarditis.
（3）在肺等疏松组织可发生组织＂实变＂，疾病：大叶性肺炎 (3) Tissue "solidification" can occur in loose tissue such as lungs, disease: lobar pneumonia
结局：吸收／机化粘连 Outcome: Absorption/mechanized adhesion
（三）化脓性炎：以中性粒细胞渗出为主，并有不同程度的组织变性，坏死和脓液形成为特征。多由化脓菌感染所致。 脓性渗出物称为脓液，含脓细胞，细菌，坏死组织碎片和少量浆液。 脓细胞是指脓液中变性坏死的中性粒细胞。 (c) Pyogenic inflammation: characterized by neutrophilic exudation with varying degrees of tissue degeneration, necrosis and pus formation. It is mostly caused by pyogenic bacterial infection. The purulent exudate is called pus and contains pus cells, bacteria, necrotic tissue debris and a small amount of plasma. Pus cells are the degenerated and necrotic neutrophils in the pus.
化脓性炎症分为： Septic inflammation is divided into:
A．表面化脓和积脓 a．发生在粘膜和浆膜的化脓性炎称表面化脓，中性粒细胞向粘膜表面渗出，而深部浸润不明显。 b．化脓性炎发生于浆膜腔或空腔脏器时，脓液积存，称为积脓e．g．化脓性心包炎，流脑（化脓性脑膜炎），小叶性肺炎 A. Surface suppuration and accumulation of pus a. Suppurative inflammation occurring in the mucous membranes and plasma membranes is called surface suppuration, with neutrophils exuding to the mucosal surface, while deep infiltration is not apparent. b. Purulent inflammation occurring in the plasma membrane cavity or cavity organs, pus accumulation, called accumulation of pus e. g. Purulent pericarditis, rheumatoid meningitis (purulent meningitis), lobar pneumonia
B．蜂窝织炎：a．发生于疏松结缔组织的弥漫性化脓性炎称蜂窝织炎 b 主要由溶血性链球菌引起 c．容易扩散（透明质酸酶，链激酶，溶解周围基质）d．好发部位：皮肤，肌肉，阑尾，肠管 B. Cellulitis: a. Diffuse purulent inflammation of loose connective tissue called cellulitis b. Caused mainly by hemolytic streptococci c. Easily spreads (hyaluronidase, streptokinase, lyses the surrounding stroma) d. Preferred sites: skin, muscles, appendix, intestinal tracts
C．脓肿：a．为局限性化脓性炎症 b．造成局部组织溶解坏死，形成脓腔 c．主要由金黄色葡萄球菌 （毒素，侵袭性酶 rarr\rightarrow 坏死，血浆凝固酶 rarr\rightarrow 病变局限）引起 d．序：毛囊皮脂腺及其周围组织的脓 C. Abscess: a. A limited purulent inflammation b. Causes localized tissue lysis and necrosis, resulting in the formation of a pus cavity c. Caused primarily by Staphylococcus aureus (toxins, invasive enzymes rarr\rightarrow necrosis, plasma coagulase rarr\rightarrow lesion confinement) d. Sequence: pus in the follicular sebaceous glands and their surrounding tissue
肿 痈：多个㾔的融合，必须及时切开排脓 Carbuncle: fusion of multiple cankers, which must be incised and drained in a timely manner
（四）出血性炎 1）微血管损伤严重，渗出物含大量红细胞 2）常见于急性传染病e．g．鼠疫 (d) hemorrhagic inflammation 1) severe microvascular damage, exudate containing a large number of erythrocytes 2) common in acute infectious diseases e. g. plague
急性炎症的结局：1．痊愈 2 。迁延为慢性炎症 3．扩散到全身 The outcome of acute inflammation: 1. Healing 2. Progression to chronic inflammation 3. Spreading throughout the body
曼延扩散：1）局部曼延，经组织间隙或自然通道向周围组织或器官直接播散（可形成糜烂，溃疡，瘘管和窦道） Mantle spread: 1) Localized mantle, direct spread to surrounding tissues or organs through tissue interstitial spaces or natural channels (can form erosions, ulcers, fistulas and sinus tracts)
2）淋巴道扩散 病原微生物进入淋巴管，随淋巴液运行，可致淋巴管炎及淋巴结炎 2) Lymphatic Tract Dissemination Pathogenic microorganisms enter the lymphatic vessels and run with the lymphatic fluid, which can lead to lymphadenitis and lymph node inflammation
3）血道扩散 3) Bloodway diffusion
菌血症：细菌入血，没有在血液中繁殖，但无全身中毒症状 Bacteremia: bacteria enter the bloodstream, do not multiply in the bloodstream, but there are no signs of systemic toxicity
毒血症：细菌毒素及其代谢产物入血并引起全身中毒症状。 Toxemia: Bacterial toxins and their metabolites enter the bloodstream and cause systemic symptoms of poisoning.
败血症：细菌入血，生长繁殖，释放毒素引起全身中毒症状，血培养阳性。 Sepsis: Bacteria enter the bloodstream, grow and multiply, and release toxins causing systemic symptoms of toxicity, with positive blood cultures.
脓毒败血症：化脓菌引起的败血症，细菌随血流至全身，在全身脏器发生多发性栓塞性脓肿。 Septic sepsis: sepsis caused by septic bacteria, in which the bacteria travel throughout the body with the bloodstream and multiple embolic abscesses develop in organs throughout the body.
五，慢性炎症 V. Chronic inflammation
1．def：（1）持续几周以上，可反复发作。（2）常表现增生病变为主，浸润的炎细胞为淋巴细胞，浆细胞和巨噬细胞。 1. def: (1) It lasts for more than a few weeks and may recur. (2) Often shows predominantly proliferative lesions, infiltrating inflammatory cells as lymphocytes, plasma cells and macrophages.
发生原因：病原微生物持续存在，理化因素长期刺激，自身免疫 Causes: persistence of pathogenic microorganisms, long-term stimulation by physical and chemical factors, autoimmunity
a．炎性息肉：炎症局部粘膜上皮，腺体及肉芽组织过度增生，形成向黏膜表面突起的带蒂的炎性肿块 a. Inflammatory polyps: inflammation of the local mucosal epithelium, glands and granulation tissue overgrowth, the formation of mucosal surface protrusion of the inflammatory mass with a tip
b．炎性假瘤：炎性增生形成境界清楚的肿瘤样团块，主要发生于眼眶，肺等实性器官，为非特异性增生（有间质，有实质） b. Inflammatory pseudotumor: inflammatory hyperplasia forming a well-defined tumor-like mass, mainly occurring in solid organs such as orbits, lungs, etc., non-specific hyperplasia (interstitial and parenchymal).
2．肉芽肿性炎：以肉芽肿形成为主要特征的炎症称为肉芽肿性炎。e．g．风湿病
显微镜下由巨噬细胞及其衍生细胞（上皮样细胞，多核巨细胞）构成的境界清楚的结节状病灶，称为肉芽肿（granuloma）
肉芽肿的主要细胞成分：上皮样细胞，多核巨细胞
肉芽肿分类：感染性肉芽肿：特征为形成结核结节，中心常为干酪性坏死，周围为类上皮细胞，可见 Langhans 巨细胞，巨细胞核排列规则，位于干细胞周边，呈花环状，病因：结核等
异物肉芽肿：如手术缝线，滑石粉等引起的肉芽肿，异物周围有异物巨细胞，核排列不规则。
大：瘤细胞大；核大；核仁大。 多：瘤细胞和核多形性；核多；核仁多；核染色质多，深染；核分裂多。 怪：瘤细胞和核奇形怪状。裂：核分裂相增多，出现病理性核分裂。胞浆呈嗜碱性组织结构异型性：指肿瘤组织在空间排列方式上与其来源的正常组织的差异。（包括实质和间质之间关系杂乱，细胞排列杂乱，失极性） Large: large tumor cells; large nuclei; large nucleoli. Polymorphic: tumor cells and nuclei polymorphic; many nuclei; many nucleoli; much nuclear chromatin, deeply stained; many nuclear divisions. Odd: tumor cells and nuclei oddly shaped. Cleavage: increased nuclear schizophrenia with pathologic nuclear fission. Basophilic cytoplasm Heterogeneity of tissue structure: refers to the difference in spatial arrangement of tumor tissues from the normal tissues from which they originate. (Includes disorganized relationships between parenchyma and mesenchyme, disorganized cellular arrangement, and loss of polarity)
间变（anaplasia）：指恶性肿瘤细胞缺乏分化状态。 间变细胞：指异型性大的细胞。 Mesenchymal (anaplasia): a state of malignant tumor cells lacking differentiation. Mesenchymal: refers to cells that are highly heterogeneous.
间变性肿瘤：主要由未分化细胞构成。间变性的肿瘤细胞具有明显的多形性，即瘤细胞彼此在大小和形状上有很大的变异，异型性大。间变性肿瘤几乎都是高度恶性的肿瘤。 Mesenchymal tumors: mainly composed of undifferentiated cells. Mesenchymal tumor cells have obvious pleomorphism, i.e., the tumor cells vary greatly from each other in size and shape and are heterogeneous. Mesenchymal tumors are almost always highly malignant tumors.
多形性：瘤细胞大小，形状的变异。 pleomorphism: variation in size, shape of tumor cells.
肿瘤细胞异形性： Tumor cell heterogeneity:
瘤细胞的多形性 体大，彼此大小和形态很不一致，可出现瘤巨细胞。但分化很差时，瘤细胞较正常细胞小，圆形，大小也比较一致。 Polymorphism of tumor cells The body is large, very inconsistent with each other in size and morphology, and may appear as tumor giant cells. However, when they are very poorly differentiated, tumor cells are smaller than normal cells, round, and more uniform in size.
瘤细胞核的多形性 核肥大，核／浆比增大，核大小，形状和染色不一，并可出现巨核，双核，多核或奇异形的核。核仁肥大，数目常增多。核分裂像常增多，特别是出现病理性核分裂像时。瘤细胞胞浆的改变 由于胞浆内核蛋白体增多而多呈嗜碱性。并可因为瘤细胞产生的异常分泌物或代谢产物而具有不同特点 Tumor cell nuclear pleomorphism Nuclear hypertrophy, increased nuclear/plasma ratio, variable nuclear size, shape and staining, and may appear macronuclei, binuclei, multinuclei, or bizarrely shaped nuclei. Nucleoli are hypertrophied and often increased in number. Nucleoli are often increased, especially in the presence of pathologic nucleoli. The cytoplasm of tumor cells is basophilic due to an increase in cytoplasmic nuclear proteasomes. They may be characterized by abnormal secretions or metabolites produced by the tumor cells.
三，肿瘤的生长与扩散 III. Tumor growth and spread
1．肿瘤的生长方式： 1. Tumor growth pattern:
a．膨胀性生长：良性肿瘤多见，呈结节状，常有完整的包膜，与周围组织分界清楚，影响主要为挤压或阻塞的作用。易手术摘除，不易复发，转移 a. Expansive growth: benign tumors are common, nodular, often with complete envelope, clearly demarcated from surrounding tissues, affecting mainly the role of extrusion or obstruction. It is easy to be removed by surgery, not easy to recur and metastasize.
b．外生性生长：良，恶性肿瘤都可，多发生在体表，体腔，管道，呈乳头状，息肉状或菜花状恶性肿瘤易发生坏死脱落而形成底部高低不平，边缘隆起的恶性溃疡 b. Exogenous growth: benign, malignant tumors can be, mostly occur in the body surface, body cavity, pipe, in the form of papillary, polypoid or cauliflower-like malignant tumors are prone to necrosis and shedding and the formation of the bottom of the uneven, raised edge of the malignant ulcers.
c．浸润性生长：多数恶性肿瘤的生长方式，没有包膜，无明显界限，如树根长入泥土，不易推动；手术摘除范围广，易复发，转移 c. Infiltrative growth: most malignant tumors grow in a way that there is no envelope, no obvious boundaries, such as tree roots growing into the soil, not easy to promote; surgical removal of a wide range of easy to recur and metastasis.
影响肿瘤生长速度的因素 Factors affecting the rate of tumor growth
a．肿瘤的倍增时间：分裂繁殖成两个细胞所需时间 a. Tumor doubling time: time required to divide and multiply into two cells
b．生长分数：肿瘤细胞群体中处于增殖状态的细胞比例 b. Growth fraction: the proportion of cells in the tumor cell population that are in a proliferative state
c．肿瘤细胞生成与死亡的比例 c. Ratio of tumor cell production to death
肿瘤生成，需要诱导血管生成。VEGF，VEGFR 饥饿疗法 Tumorigenic, need to induce angiogenesis. vegf, vegfr starvation therapy
肿瘤在生长过程中，经过多代繁殖出现侵袭性增加的现象叫肿瘤的演进 The phenomenon of increased aggressiveness of a tumor that occurs through multiple generations of reproduction as it grows is called tumor evolution
肿瘤经过多代分裂，出现基因等大分子的改变，生长速度，侵袭能力，对生长信号的反应等发生改变，称为肿瘤的异质性 Tumors undergo multiple generations of divisions and show alterations in macromolecules such as genes, and changes in growth rate, invasiveness, and response to growth signals, which are called tumor heterogeneity
2．肿瘤的扩散：指恶性肿瘤不限于发生部位生长，可侵入到邻近或远处组织生长，即蔓延及转移。途径： 2. Tumor proliferation: It means that malignant tumors are not limited to the growth of the site of occurrence, but can invade to the growth of adjacent or distant tissues, i.e., spreading and metastasis. Pathway:
1）直接蔓延：指癌瘤细胞连续浸润性生长到邻近组织或器官，如肺癌侵入胸腔，子宫颈癌侵入膀 (1) Direct spread: refers to the continuous infiltrative growth of cancer cells into neighboring tissues or organs, such as invasion of lung cancer into the chest cavity, invasion of cervical cancer into the bladder.
胱或直肠。 Bladder or rectum.
浸润：指癌瘤细胞可突破基底膜长入并破坏周围组织，是恶性肿瘤的生长特点。 Infiltration: It means that cancerous tumor cells can break through the basement membrane to grow into and destroy the surrounding tissues, and it is the growth characteristic of malignant tumors.
2）转移：癌瘤细胞从原发部位（原发瘤）分离脱落侵入一定的腔道（淋巴管，血管，体腔）被带到另一部位，并生长成与原发瘤同样类型的肿瘤（转移瘤或继发瘤）。 2) Metastasis: Cancer cells are detached from the primary site (primary tumor) and invade certain cavities (lymphatic vessels, blood vessels, body cavities) to be taken to another site and grow into the same type of tumor as the primary tumor (metastasis or secondary tumor).
转移的主要途径： The main pathway of transfer:
（1）淋巴道转移：是癌的主要转移的途径 (1) Lymphatic metastasis: the main metastatic route of cancer.
（2）血道转移：是肉瘤的主要转移的途径。途径：与血栓栓塞过程相似。血道转移最常见的是肺，其次是肝，脑，骨，肾上腺。转移瘤形态上的特点是：＂多，圆，界清，癌脐＂。 (2) Hematogenous metastasis: the main route of metastasis of sarcoma. Pathway: similar to the process of thromboembolism. Hematogenous metastasis is most common in lungs, followed by liver, brain, bone and adrenal gland. The morphology of metastatic tumors is characterized by: "many, round, clear boundary, cancer umbilicus".
癌脐：位于器官表面的转移瘤，由于瘤结节中央出血，坏死而下陷，呈脐样外观。 Cancer umbilicus: a metastatic tumor located on the surface of an organ that has an umbilical appearance due to hemorrhage in the center of the tumor node, which is necrotic and sunken.
（3）种植性转移：指体腔内器官（腹腔，胸腔，脑部器官）的恶性肿瘤曼延至器官表面时，瘤细胞可以脱落，并像播种一样种植在体腔内各器官的表面，形成多数的转移瘤。胃癌破坏胃壁侵及浆膜后，种植到卵巢形成 Krukenberg 瘤。 (3) Implantation metastasis: When malignant tumors of organs in the body cavity (abdominal cavity, thoracic cavity, brain organs) extend to the surface of the organs, the tumor cells can be detached and implanted on the surface of the organs in the body cavity like sowing seeds to form most of the metastatic tumors. Gastric cancer destroys the gastric wall and invades the plasma membrane, and then implants into the ovary to form Krukenberg tumor.
3．肿瘤的分级：I 级为分化良好，属低度恶性 II级为分化中等，属中度恶性 III级为分化低的，属高度恶性。 3. Tumor grading: Grade I is well-differentiated, low malignancy, Grade II is moderately differentiated, medium malignancy, Grade III is poorly differentiated, high malignancy.
4．肿瘤的分期（TNM 分期系统）T：肿瘤原发灶，T1～T4 N：淋巴结受累，N0～N3 M：转移 4. Tumor staging (TNM staging system) T: Tumor primary focus, T1 to T4 N: Lymph node involvement, N0 to N3 M: Metastasis
5．影响 5. Impact
（一）良性肿瘤的影响：阻塞，压迫作用：如胆管，脑室肿瘤，产生过量内分泌物质，继发性改变：包括出血，坏死，感染，破裂，囊性变。 (i) Effects of benign tumors: obstruction, compressive effects: e.g., bile ducts, ventricular tumors, production of excess endocrine material, secondary changes: including hemorrhage, necrosis, infection, rupture, cystic degeneration.
（二）恶性肿瘤的影响：1．发热 2．恶病质（cachexia）：进行性严重消瘦，体力贫乏，严重贫血，多脏器衰竭综合表现。 (ii) Effects of malignant tumors: 1. fever 2. cachexia: progressive severe emaciation, physical weakness, severe anemia, and multiple organ failure.
副肿瘤综合征：不能用肿瘤的直接蔓延或向远处转移加以解释的一些病变和临床表现，一般由肿瘤产物或异常免疫反应间接引起 Paraneoplastic syndromes: lesions and clinical manifestations that cannot be explained by the direct spread of the tumor or by metastasis to distant sites, generally caused indirectly by tumor products or abnormal immune responses
异位内分泌综合征：非内分泌肿瘤分泌激素而引起内分泌症状的现象 Ectopic endocrine syndrome: a phenomenon in which a non-endocrine tumor secretes hormones that cause endocrine symptoms
四，良性与恶性肿瘤的区别（见书 P129 表）：1．组织分化程度 2．核分裂象 3．生长速度 4．生长方式 5．继发改变 6．转移 7．复发 8．对机体影响 Differences between benign and malignant tumors (see table in P129): 1. degree of tissue differentiation 2. nuclear schizophrenia 3. growth rate 4. growth pattern 5. secondary changes 6. metastasis 7. recurrence 8. effects on the body
［相对性］：指良性肿瘤与恶性肿瘤间并无绝对界限 [Relativity]: refers to the fact that there is no absolute boundary between benign and malignant tumors.
［交界性］：指肿瘤的组织形态介乎二者之间，称交界性肿瘤 [Junctional]: A tumor whose histologic pattern is intermediate between the two is called a junctional tumor.
［转化性］：良性肿瘤，可转变为恶性肿瘤，称为恶变，如结肠息肉状腺瘤可恶变为腺癌。个别的恶性肿瘤（如黑色素瘤，神经母细胞瘤），有时由于机体免疫力加强等原因，可以停止生长甚至完全自然消退。 [Transformative]: Benign tumors can be transformed into malignant tumors, which are called malignant changes, such as polypoid adenomas of the colon can be transformed into adenocarcinomas. Individual malignant tumors (e.g. melanoma, neuroblastoma), sometimes due to the strengthening of the body's immunity and other reasons, can stop growing or even completely subside naturally.
小结：良性肿瘤与恶性肿瘤的区别：良性肿瘤分化好，生长缓慢影响小，包膜完整不转移，手术切除复发少；恶性肿瘤分化差，生长迅速危害大，浸润转移易复发，灵丹妙药抓＂三早＂。 Summary: the difference between benign tumors and malignant tumors: benign tumors are well-differentiated, slow-growing and have little impact, the envelope is intact and does not metastasize, surgical resection and fewer recurrences; malignant tumors are poorly-differentiated, fast-growing and hazardous, infiltration and metastasis are prone to recurrence, and the panacea is to grasp the "three mornings".
五，肿瘤的命名 V. Naming of tumors
1．良性肿瘤：部位＋（形态）＋组织起源＋＂瘤＂（－oma） 1. Benign tumors: site + (morphology) + tissue origin + "tumor" (-oma)
2．恶性肿瘤：部位 + （形态）+ 组织起源 2. Malignant tumors: site + (morphology) + tissue origin
＂癌＂：上皮来源的恶性肿瘤：鳞状上皮起源－－－鳞状细胞癌，腺上皮－－－－腺癌 "Carcinoma": malignant tumor of epithelial origin: squamous epithelial origin - squamous cell carcinoma, glandular epithelial - --adenocarcinoma
肉瘤：来源于间叶组织的恶性肿瘤。 癌肉瘤：一个肿瘤中既有癌的结构又有肉瘤的结构 Sarcoma: a malignant tumor originating from mesenchymal tissue. Carcinosarcoma: a tumor with both cancerous and sarcomatous structures in it
特殊命名： Special Naming:
1．组织来源＋母细胞瘤＂blastoma＂：神经，髓，肾母细胞瘤为恶性 1. Tissue origin + Blastoma: Neuroblastoma, medullary and nephroblastoma are malignant.
2．组织来源＋＂瘤＂的恶性肿瘤：精原细胞瘤，生殖细胞瘤，黑色素瘤 2. Malignant neoplasms of tissue origin + "tumor": spermatogonia, germ cell tumors, melanoma
3．＂恶性＂＋组织起源＋＂瘤＂：（恶性）淋巴瘤，恶性周围神经鞘膜瘤，恶性间皮瘤 3. "Malignant" + tissue origin + "tumor": (malignant) lymphoma, malignant peripheral nerve sheath tumor, malignant mesothelioma
4．以＂病＂，＂症＂命名：白血病，恶性组织细胞增生症，组织细胞增生症 X 等。 4. Named after "disease" or "disorder": leukemia, malignant histiocytosis, histiocytosis X, etc.
5．以人名命名：Hodgkin＇s 病，Paget＇s 病，Ewing＇s 瘤，Wilm＇s 瘤 5. Named after people: Hodgkin's disease, Paget's disease, Ewing's tumor, Wilm's tumor.
6．多种成分的肿瘤：混合瘤，畸胎瘤 6. Tumors with multiple components: mixed tumors, teratomas
7．多发性良性或交界性肿瘤：神经纤维瘤病 7. Multiple benign or junctional tumors: neurofibromatosis
常见肿瘤举例 Examples of common tumors
1．上皮性肿瘤： 1. Epithelial tumors:
［良性上皮性肿瘤］ [Benign epithelial tumors]
1）乳头状瘤 来源：由覆盖上皮（鳞状上皮，尿路上皮）发生的良性肿瘤病变特点：大体：表面呈外生性生长，形成许多手指样或乳头样突起，呈菜花样或绒毛状外观。镜下：组织结构异型性明显，细胞异型性不明显肿瘤表面覆盖有增生性上皮，如鳞状上皮柱状上皮或移行上皮；乳头中心有由纤维组织与血管构成的间质。 1) papilloma Source: benign tumor lesions occurring from the overlying epithelium (squamous epithelium, uroepithelium) Characteristics: Grossly: exophytic growth on the surface, forming many finger-like or papillae-like protrusions with cauliflower-like or downy appearance. Microscopically: the histological heterogeneity is obvious, the cellular heterogeneity is not obvious tumor surface covered with proliferative epithelium, such as squamous epithelium columnar epithelium or migratory epithelium; papillae centered on the mesenchyme composed of fibrous tissue and blood vessels.
2）腺瘤：由腺上皮发生的良性肿瘤，多见于甲状腺，卵巢，乳腺，涎腺和肠等处。 2) Adenomas: benign tumors arising from the glandular epithelium, most commonly found in the thyroid, ovaries, breast, salivary glands and intestines.
类型：A．囊腺瘤；B．管状腺瘤 Type: A. Cystadenoma; B. Tubular adenoma
病变特点 大体：在粘膜面的腺瘤多呈息肉状，腺器官内的腺瘤多呈结节状，且常有包膜 Characteristics of lesions: adenomas on the mucosal surface are polypoid, adenomas in the glandular organs are nodular and often have a peripheral membrane
镜下：组织结构异型性明显，细胞异型性不明显可见大量密集的腺体，大小形状较不规则，无导 Microscopy: the tissue structure heterogeneity is obvious, cellular heterogeneity is not obvious can be seen a large number of dense glands, the size and shape of the more irregular, no guide
管，不能排出分泌产物 Tubes, unable to expel secretion products
［恶性上皮性肿瘤］：经过淋巴道转移 [Malignant epithelial tumor]: Metastasis via lymphatic channels
1）鳞状细胞癌 来源：鳞状上皮覆盖的部位，皮肤，黏膜表面病变特点：大体：鳞癌常呈乳头状，表面坏死后可形成溃疡。 1) Squamous cell carcinoma Source: squamous epithelium covered area, skin, mucous membrane surface Lesion characteristics: gross: squamous carcinoma is often papillary, and ulcers can be formed after surface necrosis.
镜下：增生的上皮突破基底膜向深层浸润，形成不规则巢状，条索状癌巢。 Microscopy: the proliferating epithelium breaks through the basement membrane and infiltrates into the deeper layers, forming irregular nested, striated cancer nests.
a．分化好的鳞癌：I ．癌巢中心可出现层状角化物，称角化珠（keratin pearl）或癌珠；II．细胞间可见细胞间桥。 a. Well-differentiated squamous carcinoma: I. Layered keratinized material called keratin pearl or cancer pearl may appear in the center of the cancer nest. Layered keratinized material, called keratin pearl or cancer pearl, may appear in the center of cancer nests; II. Intercellular bridges can be seen between cells.
b．分化差的鳞癌：I．无角化珠形成；II．细胞间桥少或无 III．癌细胞异型性明显，核分裂像多，排列紊乱。 b. Poorly differentiated squamous carcinoma: I. No keratinized bead formation; II. Few or no intercellular bridges; III. Heterogeneity of the cancer cells is obvious, with many nuclear schizophrenia and disordered arrangement.
2）腺癌：是由腺上皮发生的恶性肿瘤，多发生于柱状上皮覆盖的粘膜及各种腺器官。 2) Adenocarcinoma: It is a malignant tumor arising from glandular epithelium, mostly occurring in the mucous membrane covered by columnar epithelium and various glandular organs.
分型：腺癌 实体癌 粘液癌 Staging: adenocarcinoma, solid carcinoma, mucinous carcinoma
病变特点：A．腺癌 大体：呈息肉状，菜花状或结节状，表面坏死脱落可形成溃疡； Characteristics of lesions: A. Adenocarcinoma: polypoid, cauliflower-like or nodular, surface necrosis and shedding can form ulcers;
镜下：I．腺癌细胞常组成大小不一，形状不一腺管状结构； Microscopy: I. Adenocarcinoma cells are often composed of glandular tubular structures of different sizes and shapes;
II．细胞有不同程度的异型性，可见核分裂像，细胞排列紊乱。 II. The cells have varying degrees of anisotropy, with visible nuclear schizophrenic images and disorganized cellular arrangement.
B．粘液癌：分泌大量粘液的腺癌 大体：多呈胶冻状，故又称为胶样癌 B. Mucinous carcinoma: adenocarcinoma secreting a large amount of mucus Gross body: mostly jelly-like, so it is also called gelatinous carcinoma.
镜下：I．癌细胞分散，细胞呈印戒状，称为印戒细胞，核在一侧，胞质内充满粘液 II．细胞间可见大量粘液。 Under the microscope: I. The cancer cells are dispersed, the cells are in the shape of imprinted cells, called imprinted cells, the nucleus is on one side, and the cytoplasm is full of mucus. II. A large amount of mucus can be seen between the cells.
C．实体癌：单纯癌由癌细胞组成实体癌巢，无腺体形成。 C. Solid carcinoma: Simple carcinoma consists of solid nests of cancer cells without gland formation.
实质多，间质少，称髓样癌 实质少，间质多，称硬癌 A carcinoma with a lot of parenchyma and little mesenchyme is called medullary carcinoma A carcinoma with little parenchyma and a lot of mesenchyme is called sclerocarcinoma
3）基底细胞癌：常见老年人头面部，浸润破坏深层组织，很少发生转移 3) Basal cell carcinoma: common in the head and face of the elderly, infiltrating and destroying deep tissues, seldom metastasized.
4）尿路上皮癌：也称移行细胞癌 4) Uroepithelial carcinoma: also called migratory cell carcinoma
2．间叶组织肿瘤： 2. Tumors of mesenchymal tissue:
［良性间叶组织肿瘤］ [Benign mesenchymal tumors]
1）纤维瘤 来源：由纤维组织发生的良性肿瘤，常见于躯干及四肢皮下。 1) Fibroma Source: Benign tumors occurring from fibrous tissues, commonly found subcutaneously on the trunk and limbs.
病变特点：大体：结节状，有包膜；切面灰白色，可见编织状条纹，质硬。 Characteristics of the lesion: gross: nodular, encapsulated; grayish-white on cut surface, weave-like streaks visible, hard.
镜下：由胶原纤维及纤维细胞组成，纤维排列呈束状，束间彼此交织；其间有血管及少量疏松结缔组织。 Microscopy: composed of collagen fibers and fibroblasts, the fibers are arranged in bundles, and the bundles are intertwined with each other; there are blood vessels and a small amount of loose connective tissue in between.
2）脂肪瘤 来源：由脂肪组织发生的良性肿瘤，最常见为背，肩，颈及四肢近端的皮下组织。 2) Lipoma Source: Benign tumor arising from adipose tissue, most commonly in the subcutaneous tissue of the back, shoulder, neck and proximal extremities.
病变特点：大体：外观：扁圆形或分叶状，有包膜，肿瘤大小不一，常为单发性，质地柔软；切面：色淡黄，似正常的脂肪组织。 Characteristics of lesions: gross: appearance: flat round or lobulated, with envelope, tumors of different sizes, often solitary, soft texture; section: yellowish color, resembling normal adipose tissue.
镜下：有包膜；瘤组织结构呈大小不规则分叶，并有不均等的纤维组织间隔存在。 Microscopically: there is an envelope; the tumor tissue structure is irregularly lobulated in size and there are uneven intervals of fibrous tissue present.
3）平滑肌瘤 来源：由平滑肌细胞发生的良性肿瘤，最多见于子宫，其次为胃肠道。 3) Smooth muscle tumor Source: benign tumors arising from smooth muscle cells, most commonly seen in the uterus, followed by the gastrointestinal tract.
病变特点：大体：外观：圆形或卵圆形，有包膜，肿瘤大小不一，单发或多发，质硬；切面：灰白色编织状。 Characteristics of the lesion: gross: appearance: round or ovoid, with periosteum, tumors of different sizes, single or multiple, hard; section: grayish-white braided.
镜下：瘤组织由形态比较一致的梭形平滑肌细胞构成。细胞排列成束状，同一束内的细胞核有时排列成栅状，互相编织。核呈长杆状，两端钝圆，核分裂像少见 Microscopy: the tumor tissue consists of spindle-shaped smooth muscle cells of relatively uniform morphology. The cells are arranged in bundles, and the nuclei within the same bundle are sometimes arranged in a fenestrated pattern, interwoven with each other. The nuclei are rod-shaped with bluntly rounded ends, and nuclear schizophrenia is rare.
4）血管瘤：重点关注非恶性，但是是浸润性生长 4) Hemangiomas: focus on non-malignant, but infiltrative growths
［恶性间叶组织肿瘤］：经血道转移，实质间质分界不清（病理诊断） [Malignant mesenchymal tissue tumor]: Metastasis via the bloodstream, poorly demarcated parenchymal mesenchyme (pathologic diagnosis)
1）纤维肉瘤 来源：由纤维组织发生的恶性肿瘤常见于躯干及四肢皮下。 1) Fibrosarcoma Source: Malignant tumors arising from fibrous tissues are commonly found subcutaneously on the trunk and extremities.
病变特点：大体：外观肿瘤呈结节状或不规则形，与周围组织分界较清楚；切面：呈灰白色或灰红色，鱼肉状。 Characteristics of the lesion: gross: appearance of the tumor is nodular or irregularly shaped, with clearer demarcation from the surrounding tissues; section: grayish-white or grayish-red, fish-like.
镜下：a．细胞大小不一，有梭形或圆形，排成编织状或漩涡状 Microscopy: a. Cells vary in size, are pike-shaped or rounded, and are arranged in a braided or swirling pattern
b．分化程度可差异很大，分化好的与纤维瘤有些相似，分化差的瘤细胞异型性十分明显，核分裂像多见。 b. The degree of differentiation can vary greatly, with well-differentiated tumors somewhat similar to fibromas, and poorly differentiated tumors with very pronounced cellular anisotropy and numerous nuclear schizophrenia.
2）骨肉瘤：由骨组织发生的恶性肿瘤，常发生于四肢长骨，半数发生在股骨下端及胫骨上端。 2) Osteosarcoma: malignant tumors arising from bone tissue, often occurring in the long bones of the limbs, with half occurring in the lower end of the femur and the upper end of the tibia.
癌与肉瘤的区别 Difference between cancer and sarcoma
1．组织来源 1. Organizational sources
2．发病率 2. Morbidity
3．大体特点 4 ．组织学特点 3. General characteristics 4. Histological characteristics
5．网状纤维 5. Reticulated fibers
6．转移 6. Transfers
六，癌症的发展过程： Sixth, the course of cancer:
［癌前病变］（precancerous lesions）：指某些疾病或病变不是恶性肿瘤，但是具有癌变的潜在可能性的病变，可以是获得性的，也可以是遗传性的。 [Precancerous lesions]: Lesions that are not malignant but have the potential to become cancerous, either acquired or hereditary, in certain diseases or lesions.
常见的癌前病变有：粘膜白斑；慢性子宫颈炎伴子宫颈糜烂；乳腺纤维囊性病；结肠／直肠的息肉状腺瘤；慢性萎缩性胃炎及胃溃疡；慢性溃疡性结肠炎；皮肤慢性溃疡；肝硬化 Common precancerous lesions include: mucosal leukoplakia; chronic cervicitis with cervical erosion; fibrocystic breast disease; polypoid adenomas of the colon/rectum; chronic atrophic gastritis and gastric ulcers; chronic ulcerative colitis; chronic ulcers of the skin; and cirrhosis of the liver.
［非典型性增生（异型增生）］指上皮组织内出现异型性细胞增生，波及／未波及全层上皮。属癌前病变。 [Atypical hyperplasia (heterogeneous hyperplasia)] refers to the appearance of heterogeneous cellular proliferation in the epithelial tissue, affecting/not affecting the entire epithelial layer. It is a precancerous lesion.
轻度（I 级）：异型性细胞增生，累及上皮层下部的 1//31 / 3 。 中度（II 级）：异型性细胞增生，累及上皮层下部的 2//32 / 3 。重度（III 级）：异型性细胞增生，累及上皮 2//32 / 3 以上但尚未达到全层。 Mild (grade I): heterogeneous cellular proliferation involving 1//31 / 3 the lower part of the epithelium. Moderate (grade II): heterogeneous cellular proliferation involving the lower part of the epithelial layer 2//32 / 3 . Severe (grade III): heterogeneous cellular hyperplasia involving more than but not all of the epithelial 2//32 / 3 layer.
［原位癌］（carcinoma in situ）上皮组织异型性细胞增生波及全层上皮，但未突破基底膜向深层浸润 ［Carcinoma in situ: Heterogeneous cell proliferation of epithelial tissue affecting the entire epithelial layer without breaking through the basement membrane and infiltrating into the deeper layers.
上皮内瘤变：上皮非典型增生和原位癌的总称 Intraepithelial neoplasia: a general term for atypical hyperplasia and carcinoma in situ of the epithelium
（正确识别癌前病变，非典型性增生及原位癌是防止肿瘤发生发展及早期诊断肿瘤的重要环节） (Proper identification of precancerous lesions, atypical hyperplasia and carcinoma in situ is an important part of preventing tumor development and early diagnosis of tumors)
七，肿瘤的分子基础（了解） VII. Molecular basis of tumors (understanding)
八，环境致瘤因素 VIII. Environmental tumorigenic factors
1．化学物质：多环芳烃（油烟，香烟，酒精，尾气），芳香胺（氨基偶氮染料），亚硝胺，真菌毒素（黄曲霉素），烷化剂酰化剂金属元素（直接致癌因素） 1. Chemical substances: polycyclic aromatic hydrocarbons (oil smoke, cigarettes, alcohol, exhaust fumes), aromatic amines (amino azo dyes), nitrosamines, mycotoxins (aflatoxins), alkylating agents acylating agents metallic elements (direct carcinogens)
2．物理因素：紫外线，电离辐射 2. Physical factors: ultraviolet light, ionizing radiation
3．生物因素：肿瘤病毒（HPV，EBV，HBV），细菌，寄生虫 3. Biological factors: tumor viruses (HPV, EBV, HBV), bacteria, parasites
第六章 心血管系统疾病 Chapter VI. Diseases of the cardiovascular system
一，动脉粥样硬化（atherosclerosis，AS）： I. Atherosclerosis (AS):
一种与血脂异常及血管壁成分改变有关的动脉疾病。（好发于大动脉，中动脉，壁变厚，硬化，弹性下降） A disease of the arteries associated with dyslipidemia and changes in the composition of blood vessel walls. (Prevalent in large arteries, middle arteries, wall thickening, hardening, loss of elasticity)
病变特征：脂质沉积于动脉内膜 rarr\rightarrow 灶性纤维性增厚＋粥样板块（粥瘤）rarr\rightarrow 动脉壁变硬 rarr\rightarrow 管腔狭窄 Characteristics: lipid deposition in intima rarr\rightarrow focal fibrous thickening + atheromatous platelets (atheroma) rarr\rightarrow arterial wall stiffening rarr\rightarrow lumen narrowing
1．危险因素 1. Risk factors
a．高脂血症：与 AS 发病密切相关的血浆胆固醇主要成分为 LDL，其中小颗粒致密低密度脂蛋白 （sLDL）是判断冠心病的最佳指标，脂蛋白 a（Lp a）在血浆浓度与 AS 发病率呈正相关 a. Hyperlipidemia: the main component of plasma cholesterol closely related to the development of AS is LDL, of which small dense low-density lipoprotein (sLDL) is the best indicator of coronary heart disease, and the plasma concentration of lipoprotein a (Lp a) is positively correlated with the incidence of AS.
b．高血压：独立危险因素，主要是引起内皮细胞的损伤 b. Hypertension: independent risk factor, mainly causing endothelial cell damage
c．糖尿病，高胰岛素血症，甲减，肾病综合征 c. Diabetes mellitus, hyperinsulinemia, hypothyroidism, nephrotic syndrome
d．遗传，年龄，性别 d. Heredity, age, gender
2．发病机制：损伤应答学说 2. Pathogenesis: the damage response theory
内皮损伤 rarr\rightarrow 脂质沉积 rarr\rightarrow LDL 氧化修饰 rarr\rightarrow 单核细胞，平滑肌细胞吞噬 LDL／ox－LDL，形成泡沫细胞 Endothelial damage rarr\rightarrow Lipid deposition rarr\rightarrow LDL oxidative modification rarr\rightarrow Monocytes, smooth muscle cells phagocytosis of LDL/ox-LDL, formation of foam cells rarr\rightarrow 平滑肌细胞分泌胶原蛋白，形成纤维帽 rarr\rightarrow 释放细胞因子引起白细胞粘附，促进炎症反应 rarr\rightarrow 泡沫细胞变性坏死，形成淡黄色粥糜样坏死物 rarr\rightarrow 后期可能发生营养不良性钙化 rarr\rightarrow Smooth muscle cells secrete collagen, forming a fibrous cap rarr\rightarrow Release of cytokines induces leukocyte adhesion and promotes an inflammatory response rarr\rightarrow Foam cells degenerate and necrose, forming a yellowish atheromatous necrotic mass rarr\rightarrow Dystrophic calcification may occur in later life
3．病理变化 3. Pathological changes
a．早期病变——脂纹（fatty streak）肉眼：动脉内膜面稍隆起的黄色斑点或条纹 a. Early lesions - fatty streak Naked eye: slightly elevated yellow spots or streaks on the intima-media surface of arteries
光镜：内皮下大量泡沫细胞聚集 + SMC（平滑肌细胞）+ 细胞外基质 泡沫细胞：圆形，体积较大，胞浆内大量小空泡 Light microscopy: large aggregates of foam cells in the subendothelium + SMC (smooth muscle cells) + extracellular matrix Foam cells: round, large in size, large number of small vacuoles in the cytoplasm
结局：病因消除可完全消退，属可逆性变化 Ending: the elimination of the cause of the disease can be completely subsided, is reversible changes
b．纤维斑块（fibrous plaque） b. Fibrous plaque
肉眼：早期为淡黄／灰黄色不规则隆起的斑块，后期胶原纤维 uarr+\uparrow+ 玻璃样变，瓷白色蜡烛油样。 Naked eye: early yellowish/grayish-yellow irregularly elevated plaques, late collagen fibers uarr+\uparrow+ vitreous, porcelain-white candle oil-like.
光镜：表层（纤维帽）：大量胶原纤维＋SMC 下层：泡沫细胞 + SMC＋脂质＋炎细胞 Light microscopy: surface layer (fibrous cap): numerous collagen fibers + SMC Lower layer: foam cells + SMC + lipids + inflammatory cells
c．粥样斑块（atheromatous plaque）——粥瘤（atheroma） c. Atheromatous plaque - atheroma
肉眼：黄色斑块＋大量黄色粥糜样物 Naked eye: yellow plaques + large amount of yellow porridge-like material
光镜：玻璃样变性的纤维帽，大量粉红无定形坏死物质和脂质十胆固醇结晶＋有时钙化，无中心粒细胞！中膜萎缩变薄，底部，周边：肉芽组织＋泡沫细胞＋淋巴细胞浸润 Light microscopy: glassy degenerated fibrous cap, large amounts of pink amorphous necrotic material and lipid ten cholesterol crystals + sometimes calcification, no centrocytes! Atrophic thinning of the mesentery, base, periphery: granulation tissue + foam cells + lymphocyte infiltration
d．继发性病变：（1）斑块内出血：新生血管破裂 rarr\rightarrow 血肿 rarr\rightarrow 狭窄，堵塞 d. Secondary lesions: (1) intraplaque hemorrhage: neovascularization rarr\rightarrow hematoma rarr\rightarrow stenosis, occlusion
（2）斑块破裂：粥瘤性溃疡 rarr\rightarrow 栓子 rarr\rightarrow 栓塞 (2) Plaque rupture: atheromatous ulcer rarr\rightarrow embolus rarr\rightarrow embolization
（3）血栓形成：内皮细胞损伤＋粥瘤性溃疡 rarr\rightarrow 血栓 (3) Thrombosis: endothelial cell injury + atheromatous ulcer rarr\rightarrow Thrombus
（4）钙化：纤维帽及粥瘤灶钙盐沉着 (4) Calcification: Calcium salt deposits in the fibrous cap and atheroma foci
（5）动脉瘤形成：动脉管壁局限性扩张 rarr\rightarrow 动脉瘤 (5) Aneurysm formation: limited dilatation of the arterial wall rarr\rightarrow Aneurysm
二，冠状 A 䉼样硬化症 CAS II, Coronary A sclerosis CAS
部位：左冠状 A\mathbf{A} 前降支 >> 右主干 >> 左旋支，左主干 >> 后降支。病变呈节段性受累。 Sites: left coronal A\mathbf{A} anterior descending branch >> right main stem >> levator ani, left main stem >> posterior descending branch. The lesion has a segmental involvement.
病变：斑块性病变，心壁侧，呈新月形，管腔呈偏心性狭窄。 Lesion: plaque lesion, lateral to the heart wall, crescent-shaped, with eccentric narrowing of the lumen.
冠状 A 性心脏病（冠心病）（CHD）：冠状 A 狭窄等变化所致的缺血性心脏病。病因：冠状 A 粥样硬化 Coronary A heart disease (coronary heart disease) (CHD): ischemic heart disease caused by changes such as coronary A stenosis. Causes: Coronary A atherosclerosis
主要临床表现 Main clinical manifestations
（一）心绞痛：类型： (i) Angina pectoris: types:
1．稳定型心绞痛 1. Stable angina
2．不稳定型心绞痛 2. Unstable angina
3．变异型心绞痛 3. Variant angina
（二）心肌梗死 病因：1．冠状动脉血栓形成 (ii) Myocardial infarction Causes: 1. Coronary artery thrombosis
2．冠状动脉痉挛 2. Coronary artery spasm
3．冠状动脉䉼样斑块内出 3. Coronary artery 䉼-like plaques within the outlet
血 4．心脏负荷过重 5．出血，休克 Blood 4. cardiac overload 5. hemorrhage, shock
1．类型（1）心内膜下心肌梗死（薄层梗死）：部位：心室壁内侧心肌 1//31 / 3 ，波及肉柱和乳头肌病变：多发性，小灶性坏死，或环状梗死，分布左心室四周，厚度不及心肌的一半。 1. Types (1) subendocardial myocardial infarction (thin-layer infarction): site: ventricular wall of the inner myocardium 1//31 / 3 , affecting the sarcomere and papillary muscle lesions: multiple, small foci of necrosis, or annular infarction, the distribution of the left ventricle around the thickness of less than half of the thickness of the myocardium.
（2）透壁性心肌梗死（区域性心肌梗死）病变：累及心室壁全层或深达室壁 2//32 / 3 以上 (2) Transmural myocardial infarction (regional myocardial infarction) lesions: involving the entire ventricular wall or reaching deep into the ventricular wall 2//32 / 3 above
" 部位: 与闭塞的冠状 A 支供血区一致 病灶: 较大, "2.5cm\text { 部位: 与闭塞的冠状 A 支供血区一致 病灶: 较大, } 2.5 \mathrm{~cm}
常见的梗死好发部位：最常见一一左前降支供血区：左室前壁，心尖部，室间隔前 2//32 / 3 及前内乳头肌 Common sites of infarction: the most common one is the left anterior descending feeder: left ventricular anterior wall, apical region, anterior septum and anterior internal papillary muscle.
其次是右冠状动脉供血区：左室后壁，室间隔后 1//31 / 3 及右心室，并可累及窦房结 The second area is the right coronary artery: the posterior wall of the left ventricle, the posterior septum and the right ventricle, and the sinus node.
再次为左旋支供血区：左室侧壁，膈面及左房，并可累及房室结 Reassertion of the left spinous branch: left ventricular lateral wall, diaphragmatic surface and left atrium, with involvement of the AV node
2．病理变化： 2. Pathological changes:
（1）发展过程：（1）梗死 < 6h:<6 \mathrm{~h}: 肉眼无变化。（2）梗死 > 6h:>6 \mathrm{~h}: 坏死灶心肌呈苍白色 (1) Progression: (1) Infarction < 6h:<6 \mathrm{~h}: no change by the naked eye. (2) Infarction > 6h:>6 \mathrm{~h}: Necrotic foci of myocardium pale in color
（3）梗死 8∼9h8 \sim 9 \mathrm{~h} 后：呈土黄色。光镜：心肌早期凝固性坏死 + 间质水肿 + 出血 + 中性粒细胞浸润（炎症反应） (3) Post-infarction 8∼9h8 \sim 9 \mathrm{~h} : yellowish color. Light microscopy: early coagulative myocardial necrosis + interstitial edema + hemorrhage + neutrophilic infiltration (inflammatory response)
（4）梗死 4 天后：充血出血带。光镜：带内血管充血，出血＋中性粒细胞浸润 uarr\uparrow 。心肌细胞肿胀，空泡变 rarr\rightarrow 核溶解消失 rarr\rightarrow 肌纤维呈空管状 (4) 4 days after infarction: congested hemorrhagic band. Light microscopy: vascular congestion within the band, hemorrhage + neutrophilic infiltration uarr\uparrow . Myocytes are swollen and vacuolated rarr\rightarrow Nucleolysis has disappeared rarr\rightarrow Myofibers are tubular.
（5）梗死 1 ∼2\sim 2 周后：边缘区出现肉芽组织（6）梗死 2∼82 \sim 8 周：梗死灶机化及瘏痕形成 (5) After 1 ∼2\sim 2 week of infarction: granulation tissue in the marginal zone (6) After 2∼82 \sim 8 week of infarction: mechanization of the infarcted foci and formation of an injury mark
3．合并症 3. Comorbidities
器质性（1）心脏破裂 Organic (1) heart rupture
（2）室壁瘤 病变：梗死心肌或瘡痕组织局限性向外膨隆 rarr\rightarrow 可继发附壁血栓，心律紊乱及左心衰竭。 (2) Ventricular wall tumor Lesion: limited outward expansion of infarcted myocardium or scar tissue rarr\rightarrow Can be followed by epiphyseal thrombus, rhythm disturbances and left heart failure.
（3）附壁血栓形成 (3) Appendage thrombosis
（4）乳头肌功能失调或断裂：常见二尖瓣乳头肌缺血坏死，造成二尖瓣脱垂或关闭不全其他（功能性）：心律失常：传导系统受累＋MI rarr\rightarrow 电生理紊乱，急性左心室衰竭：心脏收缩失调三，高血压（Hypertention）：以体循环动脉血压持续高于正常水平为主要表现的疾病。（高血压是一种体征） (4) papillary muscle dysfunction or rupture: common ischemic necrosis of the mitral papillary muscle, resulting in mitral valve prolapse or closure of the other (functional): arrhythmia: conduction system involvement + MI rarr\rightarrow electrophysiological disorders, acute left ventricular failure: cardiac contractile dysfunction III, hypertension (Hypertention): a disease in which the arterial blood pressure of the physical circulation remains persistently higher than the normal level. Hypertension: a disease characterized by persistently higher than normal blood pressure in the arteries of the body circulation. (Hypertension is a sign)
原发性高血压：是一种原因未明的，以体循环动脉血压 uarr\uparrow 为主要表现的独立性全身性疾病，以全身细动脉硬化为基本病变，常引起心，脑，肾及眼底病变及相应的临床表现，旧称高血压病。 Primary hypertension: It is an independent systemic disease of unknown cause, with arterial blood pressure uarr\uparrow in the body circulation as the main manifestation, and with systemic arteriosclerosis as the basic lesion, often causing heart, brain, kidney and fundus pathology and the corresponding clinical manifestations, which was formerly known as hypertensive disease.
【诊断标准】：成人收缩压 >= 140mmHg(18.4kPa)\geqslant 140 \mathrm{mmHg}(18.4 \mathrm{kPa}) 和／或舒张压 >= 90mmHg(12.0kPa)\geqslant 90 \mathbf{m m H g}(12.0 \mathrm{kPa})类型和病理变化 Diagnostic Criteria]: Adult systolic >= 140mmHg(18.4kPa)\geqslant 140 \mathrm{mmHg}(18.4 \mathrm{kPa}) and/or diastolic >= 90mmHg(12.0kPa)\geqslant 90 \mathbf{m m H g}(12.0 \mathrm{kPa}) type and pathologic changes.
1．缓进型高血压：良性高血压 多见（95\％），中，老年人为多，病程长，进展缓。 1. Slow-onset hypertension: benign hypertension is common (95\%), mostly in middle-aged and elderly people, with a long course and slow progress.
【病理变化】 [Pathological changes]
（1）第一期（功能紊乱期） (1) Phase I (dysfunctional period)
全身细小动脉间歇性痉挛，伴高级神经功能失调，无器质性病变，无明显症状，仅有血压 uarr\uparrow ，常有波动，可有头昏，头痛。 Intermittent spasm of small arteries throughout the body, with high-level nerve dysfunction, no organic lesions, no obvious symptoms, only blood pressure uarr\uparrow , often fluctuating, may have dizziness, headache.
（2）第二期（动脉病变期） (2) Stage II (arterial lesion stage)
细动脉硬化：主要特征病变 Fine arteriosclerosis: the main characteristic lesion
部位：肾入球 A，脾中心 A，视网膜 A－最常见 病变：细 A\mathbf{A} 壁玻璃样变（透明变性） Site: glomerulus A, splenic center A, retina A - most common lesion: A\mathbf{A} wall vitreous degeneration (hyaline degeneration)
镜检：细 A 管腔变小，内皮下间隙区 rarr\rightarrow 均质状，红染无结构玻璃样物，管壁增厚。 Microscopic examination: small lumen of fine A tubules with rarr\rightarrow homogeneous subendothelial interstitial areas, red-stained unstructured vitreous material, and thickened tubular walls.
肌型小动脉硬化：部位：肾小叶间 A，弓形 A，脑的小 A Myocardial small arteriosclerosis: site: renal interlobular A, arcuate A, small A of the brain
病变：内膜胶原及弹性纤维 uarr\uparrow ，中膜平滑肌细胞增生，肥大，血管壁增厚，管腔狭窄，大动脉无明显变化或粥样硬化
（3）第三期（内脏病变期）
心脏 rarr\rightarrow 高血压性心脏病 代偿：心脏向心性肥大 失代偿：离心性肥大
肾脏：原发性颗粒性固缩肾（细动脉性肾硬化）
病理变化：肉眼：双侧肾体积减小，重量减轻，质地变硬，表面均匀弥漫细颗粒状，切面肾皮质变薄，肾孟周围脂肪组织增生（原因：部分萎缩坏死，部分代偿性增生肥大）
镜下：入球 A\mathbf{A} 玻璃样变＋肌型小 A\mathbf{A} 硬化，肾小球纤维化和玻璃样变，肾小管萎缩，消失
间质：纤维结缔组织增生＋淋巴细胞浸润
脑病变：脑血管硬化
【脑水肿】：脑血管硬化及痉挛 rarr\rightarrow 中枢神经功能障碍
【脑软化】表现：多发，微小梗死灶 结局：无严重后果。坏死组织被吸收 rarr\rightarrow 胶质㓔痕修复
【脑出血】：最严重，致命并发症
视网膜病变：病变：视网膜中央 A 发生细小 A 硬化 眼底血管迂曲，反光增强，动静脉交叉处静脉受压；视乳头水肿，视网膜渗出，出血，表现：视力 darr\downarrow
2．急进型高血压／恶性高血压：舒张压显著升高，> 130mmHg>130 \mathrm{mmHg} 青中年多，进展迅速，易发肾衰竭。常原发，可继发
病理变化：以肾为主，也可出现于脑和视网膜，细小动脉管壁纤维素样坏死
增生性小动脉硬化：内膜增厚，平滑肌细胞增生肥大，胶原增生，管壁同心圆洋葱皮状增厚，管腔狭窄。
坏死性细动脉炎：内膜，中膜纤维素样坏死，可见核碎裂和炎细胞浸润
入球小 A 受累，肾小球毛细血管丛节段性坏死 并发症：微血栓，出血和微梗死。
四，风湿病（rheumatism）：与 A 组乙型溶血性链球菌感染有关的主要侵犯全身结缔组织的变态反应性（自身免疫性）疾病，形成特征性风湿性肉芽肿，常常累及心脏和关节（咬住心脏，舔过关节）
发病机制：抗原抗体交叉反应（糖蛋白 C\mathbf{C} 抗原和蛋白质 M\mathbf{M} 抗原）
临床表现：发热，关节疼痛，皮疹，皮下结节，抗 O 抗体升高
（1）病变部位：心包脏层 (1) Location of the lesion: the visceral layer of the pericardium
（2）病变特点：渗出性炎（纤维素／浆液） (2) Characteristics of the lesion: exudative inflammation (fibrin/plasma)
纤维素渗出为主：绒毛心（干性心包炎）浆液渗出为主：心包积液（湿性心包炎） Fibrin exudate predominant: chorioallantoic heart (dry pericarditis) Plasma exudate predominant: pericardial effusion (wet pericarditis)
后期：渗出纤维素溶解吸收 darr rarr\downarrow \rightarrow 机化粘连 rarr\rightarrow 缩窄性心包炎。 Posterior: exudative fibrin lysis and absorption darr rarr\downarrow \rightarrow Mechanized adhesions rarr\rightarrow Constrictive pericarditis.
（二）风湿性关节炎：浆液性炎 (ii) Rheumatoid arthritis: plasma inflammation
病变：滑膜充血，肿胀，关节腔浆液渗出 + 不典型风湿性肉芽肿性，胶原纤维有潻液样变和纤维素样坏死，部位：大关节，表现：游走性多关节炎（炎症表现），结局：可吸收消退，关节不变形。 （三）皮肤病变 Lesions: synovial membrane congestion, swelling, joint cavity plasma exudation + atypical rheumatoid granulomatous, collagen fibers with supplements and fibrinoid necrosis, site: large joints, manifestation: wandering polyarthritis (inflammatory manifestations), outcome: resorptive regression, joints are not deformed. (iii) Skin lesions
环形红斑：非特异性渗出性炎，淡红色环状红晕，微隆起，中央色泽正常，具诊断意义。 Circumscribed erythema: nonspecific exudative inflammation, light red circumscribed erythema, slightly elevated, with a normal-colored center, diagnostic.
皮下结节 部位：四肢大关节附近伸侧面皮下 表现：圆形倩圆结节（ 0.5∼2cm0.5 \sim 2 \mathrm{~cm} ），活动，无痛。形态：中央纤维素样坏死 外周增生纤维母细胞 + 组织细胞 + 淋巴细胞浸润（风湿性肉芽肿病变，有风湿小体）。 结局：可自行消退或留小㾊痕。 Subcutaneous nodules Location: subcutaneous on the extensor surfaces of the extremities near the large joints Presentation: round sinusoidal nodules ( 0.5∼2cm0.5 \sim 2 \mathrm{~cm} ), mobile, painless. Morphology: central fibrinoid necrosis peripheral proliferative fibroblast + histiocyte + lymphocyte infiltrate (rheumatoid granulomatous lesion with rheumatoid bodies). Ending: may resolve spontaneously or leave small 㾊 marks.
（四）风湿性动脉炎，部位：小动脉常见，如冠状 A，肾 A，肠系膜 A，脑 A，肺 A病变：血管壁纤维素样坏死 土淋巴细胞，单核细胞浸润，风湿小体。 (d) Rheumatoid arteritis, site: small arteries are common, e.g., coronary A, renal A, mesenteric A, cerebral A, pulmonary A lesions: fibrinoid necrosis of vessel wall soil lymphocytes, mononuclear cell infiltration, rheumatoid vesicles.
后期：血管壁纤维化 rarr\rightarrow 增厚 rarr\rightarrow 管腔狭窄 rarr\rightarrow 闭塞。 Posterior: vessel wall fibrosis rarr\rightarrow thickening rarr\rightarrow lumen narrowing rarr\rightarrow occlusion.
（五）风湿性脑病：纹状体，锥体外系 (v) Rheumatic encephalopathy: striatum, extrapyramidal system
五，感染性心内膜炎：是由病原微生物经过血道直接侵袭心内膜（心瓣膜）引起的炎症性疾病。常常伴有赘生物形成 Fifth, infective endocarditis: an inflammatory disease caused by pathogenic microorganisms directly attacking the endocardium (heart valves) through the bloodstream. It is often accompanied by the formation of redundant organisms
1．亚急性感染性心内膜炎（亚急性细菌性心内膜炎） 1. Subacute infective endocarditis (subacute bacterial endocarditis)
特点：毒力相对弱的病原微生物引起（草绿色链球菌）＋已有病变的瓣膜 Characteristics: caused by a relatively virulent pathogenic microorganism (Streptococcus oxysporus) + pre-existing diseased valve
赘生物呈污秽灰黄色，质松脆，易破碎，脱落 Superfluous organisms are dirty grayish-yellow in color, brittle, easily broken, and detached
赘生物组成：纤维蛋白，血小板，炎细胞，坏死物，细菌团。 Superfluous composition: fibrin, platelets, inflammatory cells, necrotic material, bacterial clusters.
病变：栓塞梗死（无菌性梗死），最常见于脑，皮下小动脉炎一欧式小结，肾小球肾炎，败血症 Lesions: embolic infarction (aseptic infarction), most commonly cerebral, subcutaneous small arteritis I eurocystic, glomerulonephritis, sepsis
2，急性感染性心内膜炎：a．起病急，多为金葡菌，化脓链球菌 b．多发生于正常心内膜，常单独侵犯主动脉瓣或二尖瓣 c．赘生物大而脆，易脱落，检塞早（含菌的栓子），败血性梗死 d．瓣膜毁损严重，迅速穿孔破裂，心衰出现早 e．病程短，可在数日或数周内死亡。 2, acute infective endocarditis: a. the onset of disease is acute, most of the aureus, streptococcus pyogenes b. most occur in the normal endocardium, often alone infringement of the aortic valve or mitral valve c. redundant organisms are large and brittle, easy to dislodge, the check is early (containing bacteria embolus), septic infarction d. valve destruction is serious, rapid perforation rupture, heart failure early e. the course of the disease is short, can be in a few days or a few weeks to death.
六，心瓣膜病：各种原因造成心瓣膜器质性病变，导致心功能不全和全身血循环障碍。 Sixth, heart valve disease: various causes of heart valve organic lesions, resulting in cardiac insufficiency and systemic blood circulation disorders.
原因：风湿性心内膜炎反复发作。其它：感染性心内膜炎，主动脉粥样硬化，梅毒 Causes: recurrent episodes of rheumatic endocarditis. Other: infective endocarditis, aortic coarctation, syphilis
部位：多见于二尖瓣，次为主动脉瓣 Site: Most common in mitral valve, followed by aortic valve
联合瓣膜病：两个以上瓣膜（如二尖瓣和主动脉瓣）同时或先后受累。 Combined valve disease: simultaneous or sequential involvement of two or more valves (e.g., the mitral and aortic valves).
1．二尖瓣狭窄：常常由风湿性心内膜炎引起 1. Mitral stenosis: often caused by rheumatic endocarditis
临床表现：心尖区舒张期隆隆样杂音 左心房扩大，呼吸困难，紫绀，血性泡沫痰（肺淤血）颈静脉扩张，肝脾肿大，下肢水肿，体腔积液。 Clinical manifestations: diastolic rumbling murmur in the apical region, enlarged left atrium, dyspnea, cyanosis, bloody frothy sputum (pulmonary stasis) jugular venous dilatation, hepatosplenomegaly, lower extremity edema, body cavity effusion.
心脏三大一小：左房，右室，右房肥大扩张，左室轻度缩小 X 线：梨形心 Three large and three small heart sizes: left atrium, right ventricle, right atrium hypertrophied and dilated, left ventricle mildly reduced X-ray: pear-shaped heart
2．二尖瓣关闭不全：临床表现：心尖区全收缩期吹风样杂音 XX 线：左右心房，心室均肥大扩张．球形心 2. Mitral valve closure insufficiency: Clinical manifestations: apical area full systolic blowing murmur XX line: left and right atria, ventricles are hypertrophied and dilated. Spherical heart
3．主动脉瓣关闭不全（由风湿性心内膜炎，亚急性感染性心内膜炎，主动脉粥样硬化引起）：舒张期主动脉血返流 rarr\rightarrow 左室肥大，扩张 rarr\rightarrow 心衰 3. Aortic valve insufficiency (caused by rheumatic endocarditis, subacute infective endocarditis, aortic atherosclerosis): diastolic aortic regurgitation rarr\rightarrow left ventricular hypertrophy, dilatation rarr\rightarrow heart failure
4．主动脉瓣狭窄：左室排血受阻 rarr\rightarrow 左室肥厚，扩张 rarr\rightarrow 左房 rarr\rightarrow 右室 rarr\rightarrow 右房肥大，靴形心 4. Aortic stenosis: left ventricular drainage blocked rarr\rightarrow Left ventricular hypertrophy, dilatation rarr\rightarrow Left atrium rarr\rightarrow Right ventricle rarr\rightarrow Right atrial hypertrophy, boot-shaped heart
第七章 呼吸系统疾病 Chapter VII. Diseases of the respiratory system
肺实质：肺内支气管的各级分支＋肺泡。 肺间质：结缔组织及血管，淋巴管，神经。 Lung parenchyma: branches of the bronchial tubes in the lungs at all levels + alveoli. Interstitium: connective tissue and blood vessels, lymphatics, nerves.
A，肺炎（pneumonia）肺组织炎症性疾病的统称，以急性渗出性炎症为主。 A, Pneumonia (pneumonia) A collective term for inflammatory diseases of the lung tissue, with acute exudative inflammation predominating.
细菌性肺炎最为常见：大叶性肺炎，小叶性肺炎，军团菌性肺炎 Bacterial pneumonia is the most common: lobar pneumonia, lobular pneumonia, legionella pneumonia
一，大叶性肺炎（lobar pneumonia）：由肺炎链球菌引起的以肺泡内弥漫性纤维素渗出为主的炎症（纤维素性炎），病变累及一个肺段或整个大叶（段及以上）。 I. Lobar pneumonia (lobar pneumonia): inflammation caused by Streptococcus pneumoniae with diffuse fibrinous exudation in the alveoli (fibrinous inflammation), with lesions involving one lung segment or the entire lobe (segments and above).
临床特征：起病急，恶寒，高热，胸痛，咳嗽，咳铁锈色痰，呼吸困难伴肺实变征及 WBC 增高。病程约一周。多见于青壮年。 Clinical features: acute onset, chills, high fever, chest pain, cough, rust-colored sputum, dyspnea with signs of solid changes in the lungs and increased WBC. Duration of the disease is about one week. Most common in young adults.
1．病因及发病机制 病原菌：肺炎链球菌为主 机体：抵抗力下降—受寒，醉酒，感冒，麻醉，疲劳等。 1. Etiology and pathogenesis Pathogenic organisms: Streptococcus pneumoniae is the main organism: decreased resistance - cold, drunkenness, cold, anesthesia, fatigue.
病变发生迅速，以肺泡毛细血管通透性 uarr\uparrow 为特点：渗出；病菌迅速蔓延一肺段，肺叶病变。 Lesions occur rapidly and are characterized by alveolar capillary permeability uarr\uparrow : exudation; rapid spread of the disease to one lung segment and lobar lesions.
2．病理变化及病理临床联系 性质：纤维素性炎 部位和范围：一般单侧，左肺或右肺下叶常见。病变分期－－－四期： 2. pathological changes and pathoclinical associations Nature: fibrinous inflammation Location and extent: usually unilateral, common in the left or right lower lobe of the lung. Staging of the lesion - stage IV:
（1）充血水肿期：1－2日 (1) Congestion and edema phase: 1-2 days
1）病变：大体：肿大，暗红色 1) Lesions: gross: enlarged, dark red color
镜下：肺泡壁毛细血管扩张，充血；肺泡腔大量浆液性渗出物，细菌；少量 RBC，中性粒细胞 Microscopy: dilated capillaries in alveolar walls, congestion; large amount of plasma exudate in alveolar lumen, bacteria; few RBCs, neutrophils
2）病理临床联系：细菌毒素入血 + 细菌入血释放毒素 rarr\rightarrow 中毒症状：寒战，高热，肌肉酸痛肺泡腔大量渗出物 + 炎细胞浸润 rarr\rightarrow 咳嗽 肺泡腔大量浆液性渗出物 + 少量 RBC rarr\rightarrow 咳淡红色痰 2) Pathologic-clinical associations: bacterial toxins in blood + bacteria in blood releasing toxins rarr\rightarrow Symptoms of poisoning: chills, high fever, muscle aches massive exudate in alveolar space + inflammatory cell infiltrate rarr\rightarrow Cough massive plasma exudate in alveolar space + small amount of RBCs rarr\rightarrow Cough pale red sputum
（2）红色肝样变期（Red hepatization）实变早期：2～4日 (2) Red hepatization (Red hepatization) Early stage of solid changes: 2 to 4 days
1）病变：镜下：肺泡壁——毛细血管扩张，充血 1) Lesions: microscopic: alveolar wall - capillary dilation, congestion
肺泡腔一大量红细胞，细菌，少量 N,MN, ~ M ；纤维蛋白原渗出 rarr\rightarrow 纤维素（呈粗的条索状，片团状分布， Alveolar lumen a large number of erythrocytes, bacteria, a small number of N,MN, ~ M ; fibrinogen exudation rarr\rightarrow Fibrin (in the form of thick cords, clumps of flakes.
意义在于有利于巨噬细胞吞噬细菌，防止细菌进一步扩散） (The significance of this is that it facilitates the phagocytosis of bacteria by macrophages and prevents the further spread of bacteria)
大体：肺肿大，重量增加，暗红，质实如肝—原因：血管扩张充血＋渗出物＋肺泡腔大量 RBC 渗出 Gross: enlarged lungs, increased weight, dark red, solid as liver - Cause: vasodilatation congestion + exudates + massive RBC exudates from alveolar cavities
2）病理临床联系：肺泡腔大量 RBCrarr\mathrm{RBC} \rightarrow 巨噬细胞吞噬，崩解—含铁血黄素：铁锈色痰； 2) Pathologic-clinical associations: alveolar cavities heavily RBCrarr\mathrm{RBC} \rightarrow phagocytosed by macrophages, disintegration-containing ferritin: rust-colored sputum;
大量 RBC，纤维素，少量 Nrarr\mathrm{N} \rightarrow 肺实变 rarr\rightarrow 缺氧：紫绀，呼吸困难；肺实变征：查体，X－ray，高热稽留浆液性渗出物（培养基）rarr\rightarrow 病菌繁殖 rarr\rightarrow 血菌 (+)(+) Large amounts of RBCs, fibrin, small amounts Nrarr\mathrm{N} \rightarrow Lung solid changes rarr\rightarrow Hypoxia: cyanosis, dyspnea; signs of lung solid changes: exam, x-ray, hyperthermia auditory plasma exudate (cultures) rarr\rightarrow Bacterial colonization rarr\rightarrow Hematobacteria (+)(+)
（3）灰色肝样变期（Gray hepatization）实变晚期，5～6日 (3) Gray hepatization (Gray hepatization) Late solid phase, 5-6 days
1）病变：镜下：肺泡壁——毛细血管受压，贫血 肺泡腔一一大量中性粒细胞，纤维蛋白量多，呈丝网状－－纤维素网；纤维素丝经肺泡间孔互相连接 1) Lesions: microscopic: alveolar wall - capillary compression, anemia alveolar lumen a large number of neutrophils, high amount of fibrin, filamentous mesh - fibrin network; fibrin filaments interconnect each other through interalveolar pores
大体：肺呈灰白色，肺肿胀；肺实变 Gross: grayish-white lungs, lung swelling; pulmonary solidity
2）病理临床联系：坏死脱落细胞 + 渗出液 + 纤维素 rarr\rightarrow 刺激 rarr\rightarrow 咳嗽 2) Pathologic-clinical associations: necrotic decidual cells + exudate + fibrin rarr\rightarrow irritation rarr\rightarrow coughing
中性粒细胞坏死 + 渗出液 + 坏死脱落上皮细胞 rarr\rightarrow 脓性痰 巨噬细胞 uarr rarr\uparrow \rightarrow 病菌阴性 Neutrophil necrosis + exudate + necrotic exfoliated epithelial cells rarr\rightarrow Purulent sputum Macrophages uarr rarr\uparrow \rightarrow Negative for germs
纤维素开始溶解＋机体适应 rarr\rightarrow 缺氧症状减轻 中性粒细胞＋纤维素 rarr\rightarrow 肺实变 -x 线，体征 Fibrin begins to dissolve + organism adapts rarr\rightarrow Hypoxic symptoms reduced Neutrophils + fibrin rarr\rightarrow Lung solid lesions - x-ray, physical signs
（4）溶解消散期 第7－10日 (4) Dissolution and dissipation period Days 7-10
1）病变：镜下：巨噬细胞 uarr\uparrow ，中性粒细胞变性坏死 rarr\rightarrow 渗出物（主要为纤维素）溶解（中性粒细胞释放的蛋白水解酶） 1) Lesions: microscopic: macrophages uarr\uparrow , neutrophils degenerate and necrotic rarr\rightarrow exudate (mainly fibrin) lysis (protein hydrolases released by neutrophils)
大体：质地变软，切面颗粒外观渐消失，可有脓样混浊液体 渗出物被溶解 rarr\rightarrow 肺体积缩小 Gross: texture softens, granular appearance fades in section, may have purulent cloudy fluid Exudate is lysed rarr\rightarrow Lungs decrease in size
渗出物主要为纤维素，RBC 较少 rarr\rightarrow 肺灰白色 渗出物被溶解 rarr\rightarrow 经淋巴管吸收或咳出 rarr\rightarrow 肺实变 （持续时长 3－4 周，故复查周期为一个月左右） Exudate mainly fibrin, less RBCs rarr\rightarrow Lung grayish-white Exudate dissolved rarr\rightarrow Absorbed through lymphatics or coughed up rarr\rightarrow Lung solid (lasts 3-4 weeks, so review cycle is about a month)
2）病理临床联系：咳嗽，渗出物 + 坏死的中性粒细胞 rarr\rightarrow 咳痰 2) Pathologic-clinical associations: cough, exudate + necrotic neutrophils rarr\rightarrow coughing up sputum
3．结局及并发症 3. Outcome and complications
（1）痊愈：大叶性肺炎通常为急性渗出性炎症，故肺组织常无坏死，肺泡壁结构未遭破坏 rarr\rightarrow 结构和功能恢复痊愈 (1) Cured: lobar pneumonia is usually an acute exudative inflammation, so the lung tissue is often not necrotic, and the alveolar wall structure has not been damaged rarr\rightarrow Structure and function restored and cured.
（2）并发症：a．中毒性休克 b．肺脓肿及脓（气）胸：金黄色葡萄球菌 c．败血症或脓毒败血症：严重感染 d．胸膜炎 e．肺肉质变（pulmonary carnification）：灰肝期，中性粒细胞渗出过少 rarr\rightarrow 蛋白溶解酶不足 rarr\rightarrow 渗出物不能及时溶解吸收 rarr\rightarrow 肉芽组织长入 rarr\rightarrow 机化 rarr\rightarrow 病变呈褐色肉样。 (2) Complications: a. Toxic shock b. Pulmonary abscess and pus (pneumothorax): Staphylococcus aureus c. Septicemia or septicemia: severe infection d. Pleurisy e. Pulmonary carnification: gray liver stage, with too little neutrophil exudate rarr\rightarrow Insufficient proteolytic enzymes rarr\rightarrow Exudate can't be absorbed in time. Lysis and absorption rarr\rightarrow Granulation tissue grows in rarr\rightarrow Mechanization rarr\rightarrow Lesion is brown and fleshy.
（二）小叶性肺炎（lobular pneumonia）化脓菌引起，以肺小叶为病变单位的急性化脓性炎。常以细支气管为中心，又称支气管肺炎。常是某些疾病的并发症。常见小儿和年老体弱者，肺小叶临床表现：发热，咳嗽，粘液脓性痰，呼吸困难和肺部散在湿罗音。 (B) lobular pneumonia (lobular pneumonia) caused by Pseudomonas aeruginosa, acute suppurative inflammation of the lung lobules as the lesion unit. Often centered on the fine bronchi, also known as bronchopneumonia. It is often a complication of certain diseases. Commonly found in children and the elderly and infirm, the clinical manifestations of pulmonary lobules: fever, cough, mucopurulent sputum, dyspnea and scattered wet rhonchi in the lungs.
1．病因和发病机制： 1. Etiology and pathogenesis:
1）病原：细菌（化脓菌：肺炎链球菌，葡萄球菌等），病毒，霉菌 1) Pathogens: Bacteria (Pseudomonas: Streptococcus pneumoniae, Staphylococcus, etc.), viruses, molds
2）机体抵抗力 darr\downarrow 2) Organismal resistance darr\downarrow
两种特殊情况：坠积性肺炎，吸入性肺炎 Two special cases: crashing pneumonia, aspiration pneumonia
2．病理变化及病理临床联系 特征：肺组织急性化脓性炎，多以细支气管为中心，中心粒细胞浸润。病变从细支气管 rarr\rightarrow 周围或末梢肺组织 rarr\rightarrow 形成以肺小叶为单位，灶状散布的炎症灶。 2. Pathological changes and pathological and clinical associations Characteristics: acute purulent inflammation of the lung tissue, mostly centered on the fine bronchioles, with central granulocytic infiltration. Lesions from the rarr\rightarrow peripheral or terminal lung tissue rarr\rightarrow formation of lung lobules as a unit, focally scattered foci of inflammation.
1）病理变化 大体：肺内多发性，散在分布，斑片状实变病灶，两肺各叶，背侧，下叶较多病灶多为小叶范围（ d0.5-1cm\mathbf{d} \mathbf{0 . 5 - 1 c m} ），不规则，切面致密，灰黄色，脓性渗出物 1) Pathologic changes Grossly: multiple, scattered, patchy solid lesions in the lungs, each lobe of the lungs, dorsal, lower lobe more foci mostly lobular in extent ( d0.5-1cm\mathbf{d} \mathbf{0 . 5 - 1 c m} ), irregular, dense, grayish-yellow, purulent exudate on the cut surface
镜下：病灶中央或周围有细支气管 细支气管管壁：充血，水肿， N 为主的炎细胞浸润 Microscopy: fine bronchi in or around the center of the lesion Fine bronchial walls: congestion, edema, N-dominant inflammatory cell infiltrate
管腔：脓性渗出物，纤维蛋白较少，病灶周肺泡腔有大量浆液， N,\mathrm{N}, ~ 纤维蛋白较少。 Lumen: purulent exudate, less fibrin, perifocal alveolar lumen with large amounts of plasma, N,\mathrm{N}, ~ less fibrin.
重者融合成片或累及全叶 rarr\rightarrow 融合性支气管肺炎（confluent bronchopneumonia） In severe cases, it fuses into patches or involves the whole lobe rarr\rightarrow Confluent bronchopneumonia
2）临床表现：常为原发疾病掩盖。 炎症＋脓性渗出物 rarr\rightarrow 咳嗽，咳痰（粘液脓性痰）X－ray－－－不规则小片状，斑点状模糊阴影 2) Clinical manifestations: often masked by primary disease. Inflammation + purulent exudate rarr\rightarrow Coughing, coughing up sputum (mucopurulent sputum) X-ray - irregular small flakes, speckled fuzzy shadows
3．结局及并发症：1）痊愈：及时治疗，渗出物完全吸收 3. Outcome and complications: 1) Cured: timely treatment, complete absorption of exudate
2）并发症：危险性比大叶性肺炎大得多，可有呼衰，心衰，败血症，脓胸，支气管扩张等。 2) Complications: the danger is much greater than that of lobar pneumonia, and there can be expiratory failure, heart failure, sepsis, septic chest, bronchodilatation, and so on.
（1）病因：上呼吸道病毒感染向下蔓延所致的肺部炎症，病毒－－流感病毒，腺病毒，麻疹病毒，巨细胞病毒等，单一或混合感染（多种病毒＋继发细菌）。常常通过飞沫传播 (1) Causes: inflammation of the lungs due to downward spread of viral infections of the upper respiratory tract, viruses - influenza virus, adenovirus, measles virus, cytomegalovirus, etc., single or mixed infections (multiple viruses + secondary bacteria). Often spread by droplets
（2）病理变化及病理临床联系 病理变化：间质性炎症，充血水肿 (2) Pathologic changes and pathologic-clinical associations Pathologic changes: interstitial inflammation, congestion and edema
变质性炎：肺泡壁上皮细胞变性坏死 Metaplasia: degeneration and necrosis of alveolar wall epithelial cells
两大病理损伤：透明膜，包涵体 Two major pathologic injuries: hyaline membrane, inclusion bodies
一般肺泡腔无渗出，若有，则为浆液纤维素性渗出物，均匀红染——透明膜 Generally no exudation from alveolar cavities, if any, plasma-fibrinous exudate, uniformly red-stained - hyaline membrane
病毒包涵体（viruses inclusions）：圆形或椭圆形，约红细胞大小，嗜酸性，周围常有一清晰的透明晕 部位：上皮细胞／多核巨细胞内，胞核一巨细胞病毒，腺病毒，胞浆一呼吸道合胞病毒，胞核和胞浆都有 意义：诊断病毒性肺炎的重要依据 Viruses inclusions: round or oval, about the size of a red blood cell, eosinophilic, often surrounded by a clear halo Location: in epithelial cells/polynuclear giant cells, cytomegalovirus, adenovirus, cytoplasmic respiratory syncytial viruses, both cytomegalovirus and cytomegalovirus Significance: Important in the diagnosis of viral pneumonia.
多核巨细胞（giant cells ）：支气管和肺泡上皮增生 rarr\rightarrow 多核巨细胞 Giant cells: bronchial and alveolar epithelial hyperplasia rarr\rightarrow Giant cells
病理与临床联系：炎症－－－剧烈咳嗽 渗出－－－缺氧，呼吸困难（注意：无痰）＝病毒－－－中毒症状。 Pathologic and clinical links: inflammation - severe coughing exudation - hypoxia, dyspnea (note: no sputum) = viral --Toxicity symptoms.
三，间质性肺炎：管壁，小叶间隔，肺泡隔等肺间质的炎症。多由支原体感染引起。（阿奇霉素） Third, interstitial pneumonia: inflammation of the interstitium of the lungs such as the walls of the tubes, the interlobular septa, and the alveolar septa. Mostly caused by mycoplasma infection. (Azithromycin)
B，慢性阻塞性肺疾病（chronic obstructive pulmonary diseases，COPD）一组慢性可逆性／不可逆性气道阻塞，呼气阻力增加，肺功能不全为共同特征的疾病统称。 B, chronic obstructive pulmonary diseases (chronic obstructive pulmonary diseases, COPD) a group of chronic reversible/irreversible airway obstruction, increased expiratory resistance, pulmonary insufficiency as a common feature of the disease collectively.
包括慢性支气管炎，肺气肿，支气管扩张，支气管哮喘。 This includes chronic bronchitis, emphysema, bronchiectasis, and bronchial asthma.
一，慢性支气管炎（chronic bronchitis）气管，支气管粘膜及其周围组织的慢性非特异性炎，以支气管粘膜，粘膜下增生为主要病变。临床表现－－咳，痰，喘，> 3m//>3 \mathrm{~m} / 年，> 2y>2 \mathrm{y} 。 First, chronic bronchitis (chronic bronchitis) trachea, bronchial mucosa and its surrounding tissues of chronic non-specific inflammation, bronchial mucosa, submucosal hyperplasia as the main lesion. Clinical manifestations - cough, sputum, wheezing, > 3m//>3 \mathrm{~m} / years, > 2y>2 \mathrm{y} .
（一）病因和发病机制：1．感染：病毒，细菌 rarr\rightarrow 粘膜上皮损伤，防御 darr2\downarrow 2 ．吸烟：粘膜上皮损伤，防御 darr,M\downarrow, \mathrm{M} 吞噬 darr3\downarrow 3 ．大气污染和气候变化：有害气体，寒冷 4 ．过敏因素 (I) Etiology and pathogenesis: 1. Infection: viruses, bacteria rarr\rightarrow Mucosal epithelial damage, defense darr2\downarrow 2 ． Smoking: mucosal epithelial damage, defense darr,M\downarrow, \mathrm{M} phagocytosis darr3\downarrow 3 ． Air pollution and climate change: harmful gases, cold 4. Allergic factors
（二）病理变化：早期：累及气管，大中支气管 晚期：细小支气管炎及其周围炎 (ii) Pathologic changes: Early stage: involvement of trachea, large and medium-sized bronchi Late stage: fine bronchitis and its periphery
镜下：1，粘膜上皮损伤与修复：纤毛粘连，倒伏，脱失；上皮细胞变性，坏死；再生，鳞化； Microscopy: 1, Mucosal epithelial damage and repair: cilia adherence, inversion, loss; epithelial cell degeneration, necrosis; regeneration, squamization;
杯状细胞 uarr\uparrow 。修复时可伴有鳞状上皮化生 Cup cells uarr\uparrow . Repair may be accompanied by squamous epithelial hyperplasia
2，腺体增生，肥大及粘液腺化生，后期腺体可萎缩 2, Glandular hyperplasia, hypertrophy and mucous glandular chemosis, later the gland can atrophy
3，支气管壁的慢性炎症损害：充血，淋巴，浆细胞浸润；平滑肌束断裂，萎缩；软骨变性，萎缩， 3, Chronic inflammatory damage to the bronchial wall: congestion, lymphoid, plasma cell infiltration; smooth muscle bundles fracture, atrophy; cartilage degeneration, atrophy, and
钙化或骨化；细支气管炎和周围炎。 Calcification or ossification; fine bronchitis and periostitis.
大体：粘膜上皮及支气管壁损害 rarr\rightarrow 支气管粘膜粗糙，充血，水肿 腺体病变 rarr\rightarrow 粘性或脓性分泌物 （三）病理与临床联系：支气管粘膜炎症 rarr\rightarrow 咳嗽 Gross: mucosal epithelial and bronchial wall damage rarr\rightarrow Bronchial mucosa rough, congested, edematous Glandular lesions rarr\rightarrow Viscous or purulent secretions (c) Pathologic and clinical associations: bronchial mucosal inflammation rarr\rightarrow Coughing
杯状细胞，粘液腺体，分泌物 uarr rarr\uparrow \rightarrow 咳痰（白色粘液泡沫痰／脓性痰－－急性期） Cup cells, mucous glands, secretions uarr rarr\uparrow \rightarrow Coughing up sputum (white mucous foamy sputum/purulent sputum - acute phase)
支气管狭窄／痉挛＋渗出物 rarr\rightarrow 阻塞 rarr\rightarrow 喘，罗音，哮鸣音 慢性萎缩性支气管炎 rarr\rightarrow 无痰。 Bronchial stenosis/spasm + exudates rarr\rightarrow Obstruction rarr\rightarrow Wheezing, rhonchi, rales Chronic atrophic bronchitis rarr\rightarrow No sputum.
（四）结局及并发症：1．痊愈 (iv) Outcome and complications: 1. Cured
2．并发症：（1）慢性阻塞性肺气肿（2）支气管扩张症（3）支气管肺炎（4）肺癌 2. Complications: (1) chronic obstructive pulmonary emphysema (2) bronchiectasis (3) bronchopneumonia (4) lung cancer
二，支气管哮喘：内，外因素（遗传等）引发呼吸道过敏反应 rarr\rightarrow 以弥漫性细支气管痉挛为特征的支气管慢性炎性疾病。 Second, bronchial asthma: endogenous and exogenous factors (genetic, etc.) trigger respiratory allergic reactions rarr\rightarrow Chronic inflammatory disease of the bronchial tubes characterized by diffuse spasm of the fine bronchial tubes.
临床表现：发作性喘息十哮鸣音的呼气性呼吸困难等。 慢性疾病，可视为慢性阻塞性细支气管炎的一种特殊类型。 Clinical manifestations: episodes of wheezing ten croupy expiratory dyspnea and so on. Chronic disease, can be regarded as a special type of chronic obstructive fine bronchitis.
（一）病因和发病机制：遗传因素＋过敏（过敏原反复接触，感染，冷空气，烟雾等）因素： (i) Etiology and pathogenesis: genetic + allergic (repeated exposure to allergens, infections, cold air, smoke, etc.) factors:
（1）抗原 rarr B\rightarrow B 细胞 rarr\rightarrow 浆细胞 IgE uarr rarr\uparrow \rightarrow 肥大，嗜碱性粒细胞致敏 -+ 过敏原 rarr\rightarrow 释放组胺，缓激肽等 rarr\rightarrow 气管平滑肌收缩 rarr\rightarrow 速发型哮喘反应 (1) Antigens rarr B\rightarrow B Cells rarr\rightarrow Plasma cells IgE uarr rarr\uparrow \rightarrow Mast, basophilic sensitization -+ Allergens rarr\rightarrow Release of histamine, bradykinin, etc. rarr\rightarrow Contraction of tracheal smooth muscle rarr\rightarrow Rapid-onset asthma response
（2）PAF，花生四烯酸代谢产物，水解酶 rarr\rightarrow 嗜酸性，中性粒细胞趋化因子 rarr\rightarrow 嗜酸性，N,MN, ~ M 细胞浸润 rarr\rightarrow 释放炎症介质 rarr\rightarrow 组织损伤 rarr\rightarrow 迟发型哮喘反应 (2) PAF, arachidonic acid metabolite, hydrolase rarr\rightarrow eosinophilic, neutrophil chemotactic factor rarr\rightarrow eosinophilic, N,MN, ~ M cellular infiltration rarr\rightarrow release of inflammatory mediators rarr\rightarrow tissue damage rarr\rightarrow delayed asthmatic response
（二）病理变化 镜下：1，粘膜上皮损害，杯状细胞 uarr\uparrow (ii) Pathologic changes Microscopy: 1, mucosal epithelial damage, cup-shaped cells uarr\uparrow
2，粘膜基底膜 uarr\uparrow ，玻变，粘液腺增生 2, Mucosal basement membranes uarr\uparrow , glassy lesions, mucous gland hyperplasia
3，管壁平滑肌：肥大，嗜酸性及单核细胞浸润 4，粘液栓：Charcot－Leyden 结晶等大体：粘膜基底膜 uarr+\uparrow+ 平滑肌肥大 + 粘液栓 + 炎症 rarr\rightarrow 细支气管狭窄，痉挛 rarr\rightarrow 肺含气量 uarr rarr\uparrow \rightarrow 肺膨胀，柔软，有弹性症 rarr\rightarrow 粘膜充血，水肿 rarr\rightarrow 管腔狭窄。 3, Tubular wall smooth muscle: hypertrophy, eosinophilic and mononuclear cell infiltration 4, Mucus plugs: Charcot-Leyden Crystallization et al. Gross: mucosal basement membrane uarr+\uparrow+ Smooth muscle hypertrophy + Mucus plugs + Inflammation rarr\rightarrow Fine bronchial stenosis, spasticity rarr\rightarrow Lung air-containing capacity
