病理学Chapter 3.2修复(英文).ppt

Granulation tissue → Fibrous tissue → Scar The development of granulation tissue Repair Repair Repair Ⅱ. Scar formation 纤维性修复 Angiogenesis Steps in scar formation 1.原有血管基膜蛋白水解降解 2.原有内皮细胞迁移 3.内皮细胞增生 4.内皮细胞成熟形成血管腔 血管周细胞、平滑肌细胞增生 5.新生血管通透性高，肉芽组织水肿明显 Angiogenesis from endothelial precursor cells Repair Repair Ⅱ. Scar formation 纤维性修复 Migration and proliferation of fibroblasts and deposition of connective tissue Steps in scar formation Maturation and reorganization of the fibrous tissue (remodeling) ECM degrade matrix metalloproteinase (MMPs, 基质金属蛋白酶)。 ①interstitial collagenase(间质胶原酶) ColⅠ和ColⅢ ②type Ⅳ collagenase (Ⅳ型胶原酶) ColⅣ和ColⅤ ③stromelysin(基质溶解素) 蛋白多糖和连接糖蛋白 ④membrane-type MMP(膜型MMP) MMP-2、ColⅠ和ColⅢ ⑤other (MMP11、MMP12) Remodeling of granulation tissue Repair Ⅱ. Scar formation 纤维性修复 Steps in scar formation Repair Ⅱ. Scar formation 纤维性修复 Steps in scar formation 早期 血管多，Fb，渗出液，炎细胞 颗粒状，肉红色，柔韧，光泽 后期（瘢痕组织） 血管少，胶原多，致密 灰白色，质硬，弹性差 Systemic factors： nutrition(营养) Metabolic sttus(代谢状况) Circulatory sttus(循环状况) Hormones(激素) Local factors： Infection(感染) Mechanical factors(机械磨擦) Foreign bodies(异物) Size, location and type of wound (大小、部位、伤口类型） Repair Ⅲ. Factors that influence tissue repair 影响修复的因素 年龄 细胞不足 药物影响 疾病影响 Complications in cutaneous wound healing （并发症）： Deficient scar formation瘢痕形成不足 Wound dehiscence(伤口裂开) Ulceration（溃疡） Excessive formation of the repair components瘢痕形成过度 keloid（瘢痕疙瘩） aggressive fibromatoses （侵袭性纤维瘤病） Formation of contractures挛缩 Deformities of the wound and the surrounding tissue Repair Ⅲ. Factors that influence tissue repair 影响修复的因素 瘢痕疙瘩 Keloid keloid（瘢痕疙瘩） Repair Keloid Hyaline degeneration of collagen in a keloid 瘢痕挛缩 Healing by first/second intention 一期愈合、二期愈合 Cutaneous Wound Inflammation Granulation Tissue Reepithelialization Healing Repair Ⅳ. Wound healing 创伤愈合 Repair 一期愈合 二期愈合 创面窄而齐 出血损伤少 无感染 创面大 出血损