• • • • • • Cornelius Celsus (ancient Rome) described rubor (redness), calor (heat -- this applies only to the skin), dolor (pain), and tumor (which then simply meant "swelling") as the "cardinal signs of inflammation". John Hunter (the great early surgeon, * 1793, * parodied by William Blake as "Jack Tearguts") first characterized inflammation as a nonspecific body response. Rudolf Virchow added functio laesa (loss of function) as the fifth cardinal sign of inflammation, and his student, Julius Cohnheim, provided the basic studies of the pathologic microanatomy of inflammation. Elie Metchnikoff (* 1892) was the first to observe and study phagocytosis. (* This is the same Metchnikoff who popularized yogurt as a "health and longevity food". He died at age 70.) Paul Ehrlich developed the idea of humoral immunity early in this century. (This is the same Ehrlich who developed the "magic bullet" for syphilis, and most of the stains we still use.) Thomas Lewis demonstrated that inflammation is brought about by chemical mediators, most of which act locally. Someone may still ask you about the "triple response of Lewis" to a superficial scratch: (1) an immediate red scratch mark; (2) a red flare around the scratch mark; (3) a red swollen area ("wheal") around the flare. (Try it!) Dr. Lewis found that he could eliminate the flare, but not the others, by cutting the autonomic nerve supply (i.e., preventing the "axon reflex"). This experiment led to the discovery of histamine, which mediates events 1 and 3.
HEALTH & DISEASE
PEACE & WAR
炎症与损伤的修复
Inflammation and Repair
By Dr. S. J. YANG
Department of Patholgy, 4th Military Medical University
学习内容
1. 炎症的概念(Conception of Inflammation) 2. 病因(Etiologic Agents) 3. 局部表现和全身反应(Local and Systemic Manifestations – Signs & Symptoms) 4. 炎症的基本病理变化(Morphologic Patterns of Inflammation) 5. 急性性炎症类型及特点、发病机制(Acute Inflammation and Pathogenesis) 6. 损伤的修复(Repair) 7. 慢性炎症及其类型和特点 (Chronic Inflammation) 8. 炎症的结局(Prognosis of Inflammation)
慢性胆囊炎时粘膜上皮和腺体增生
2、间质细胞增生：包括巨噬细胞、血管内 皮细胞和成纤维细胞
炎症的类型 Classification of inflammation
急性炎症：病程短，几天－ 1月，以变质渗出为主
临床类型
慢性炎症：病程长， 数月－数年，以增生为主
OUTCOMES OF INFLAMMATION
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Fever - clinical hallmark of inflammation
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Endogenous pyrogens: IL-1 and TNF-a
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Leukocytosis - may be neutrophils, eosinophils, or lymphocytes Leukopenia - rare Acute Phase Reactants - non-specific elevation of many serum proteins - will markedly increase the “sed rate”
炎症的致病原因
Etiologic Agents of Inflammation
Local and systemic manifestations
Acute Inflammation
Cardinal Signs (Celsus, 1 AD)
• • • • •
Redness (rubor) Swelling (tumor) Heat (calor) Pain (dolor) Loss of function (functio laesa) (the fifth cardinal sign supposedly added by Virchow)
Inflammation
Definition
• 各种致炎因子引起机体的组织损伤所诱 发的以防御为主的局部组织反应。(第一 版） • 具有血管系统的活体组织对损伤因子所 发生的防御反应。（第四版）
Inflammation and repair - Defensive reaction. Defensive ? Defective ?
变质：Alteration 基本病变 渗出：Exudation
增生：Proliferation 变质和渗出出现于早期，而增生出现于晚期
变质（Alteration）
1、概念：
炎症局部组织发生的变性和坏死
2、原因：
致病因子直接作用
局部血液循环障碍
免疫介导
炎症反应产物的间接作用
3、变质的细胞的类型和形态变化
变性：细胞水肿、脂肪变性
实质细胞
坏死：凝固性和液化性坏死
变性：黏液变性、玻璃样变性
间质细胞
坏死：纤维素样坏死
渗出 (Exudation) 1、概念： 炎症局部组织血管内的液体成分、蛋白质 和各种白细胞通过血管壁进入 组织、体腔
、体表和粘膜表面的过程，称为渗出
渗出是炎症n ) 1、实质细胞增生：肝炎时，肝细胞的再生
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Initiation(开始或启动) – 血管反应为中心
• • •
Stimulation (injury) with changes in microvasculature Structural changes leading to extravasation Emigration of WBCs to the site of injury
Spreading
Bacteremia Toxemia Septicemia Pyemia *The longer the stimulus persists, the greater the
Story of mice
急性炎症
PHASES OF INFLAMMATION • Initiation • Amplification • Termination
Definition by Big Robbins
“Inflammation is the
reaction of living tissues to all form of injury. It involves vascular, neurologic, humoral and cellular response at the site of injury” （Basic Pathology）
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•
Amplification(扩大或进展)* - 炎症介质和炎细 胞的作用－Both soluble mediators and cellular inflammatory systems are activated and amplified Termination(终止)* - 再生、修复和愈合 accomplished by specific inhibition or dissipation of the mediators
Acute Inflammation
Cardinal Signs - Redness
Acute Inflammation
Cardinal Signs - Swelling
Acute Inflammation