病理生理学 （PathophysiologyPathophysiology）第二章 疾病概论1病理生理学2疾病的相关概念病理生理学疾病（disease） 原始社会疾病是鬼神作怪的结果 古印度医学疾病是气、胆、痰三种“体液”的失衡 中国古代医学疾病是阴阳五行的失调 古希腊医学家Hippocrates疾病是由于来自心脏的血液、肝脏的黄胆汁、脾脏的黑胆汁和脑中的黏液四种元素的失衡所引起 3病理生理学4Hippocrates (460 BC377 BC) established the fundamentals of anatomy, physiology, and pathology that served as the earliest knowledge for understanding health and disease病理生理学Hippocratess definition of “disease”The disease occurred when the four humors became out of balance:Blood from the heartYellow bile from the liverBlack bile from the spleenPhlegm from the brainParallel in Chinese “Yin and Yang”5病理生理学Galen (129199, AC): introduced experimentation into the study of healingAccording to Galen, the body carried three kinds of blood that contained spirits charged by various organs: the veins carried “natural spirit” from the liverthe arteries, “vital spirit” from the lungsthe nerves, “animal spirit” from the brainencyclopedia of anatomy and physiology6病理生理学Andreas Vesalius (1514 1564) professor of anatomy and surgery at Padua, Italy. His published work, On the Structure of the Human Body, showing how the parts of the body looked and worked, set a new standard for the understanding of human anatomy7病理生理学William Harvey (15781657) the English physician and physiologist, who in his book, On the Motion of the Heart and Blood in Animals (1628), provided a physiologic framework for the circulation of blood8病理生理学William Harveys most eminent patient, King Charles I, and the future King Charles II look on as Harvey displays a dissected deer heart9The first vaccination(1796). Edward Jenner (17491823) conducted the first vaccination by injecting the fluid from a dairymaids cowpox lesion into a young boys arm. The boy developed cowpox but not smallpox The 19th century was a time of major discoveries that paved the way for understanding infectious diseases 病理生理学In the 19th century Joseph Lister: concluded that microbes caused wound infections Robert Koch, who discovered the anthrax bacillus Louis Pasteur, who developed the technique of pasteurization Wilhelm Roentgen, discovered X rays 10病理生理学Florence Nightingale caring for wounded during the Crimean War (1854-1856)11病理生理学In the 20th century In 1910, Paul Ehrlich introduced chemotherapy (arsenic compound Salvarsan against syphilis) In 1928, Sir Alexander Fleming discovered the first antibiotic12病理生理学In the 20th century In 1922, discovery of insulin by Sir Frederick Banting and Charles Best In 1953, development of the polio vaccine by Jonas Salk In 1967, John Gibbon created the heart-lung machine13病理生理学In the 20th century Charles Darwins (18091882) evolutionary theories about inherited traits Gregor Mendels (18221884) theories on the segregation of traits, which laid the groundwork for establishing the chromosome as the structural unit of heredity14病理生理学In the 20th century In the early 1950s, geneticist James Watson of the United States and British biophysicists Francis Crick and Maurice Wilkins presented their findings on the double-helical structure of DNA The substantial mapping of the human genome that has taken place15病理生理学疾病（disease） 现代疾病是在一定病因作用下，机体内稳态调节紊乱而导致的异常生命活动过程。 损伤与抗损伤损伤与抗损伤16病理生理学疾病（disease）病理过程（pathological process） 许多疾病中共存的成套病变如：炎症、发热、缺氧、休克、心衰、呼衰等 疾病由病理过程组成如：出血热由凝血障碍、发热、休克、肾功衰等组成17病理生理学健 康 健康是心身健康的总称，它有赖于内外环境的协健康是心身健康的总称，它有赖于内外环境的协 调与平衡调与平衡 The definition from WHO (1948): As a “state of complete well-being and not merely the absence of disease and infirmity.” 健康不仅是没有疾病，而是躯体上、精神上和社 会适应上的一种完好状态 18病理生理学亚健康状态（sub-health） 指介于健康与疾病之间的一种生理功能低下状态（75%的人群处于亚健康状态） 躯体性亚健康状态 心理性亚健康状态 人际交往性亚健康状态 引起亚健康的原因复杂积极、健康的生活、工作和思维方式，可使亚健康可向健康转化 19病理生理学20病因学病理生理学病因学（etiology） 病因学研究疾病发生的原因与条件 病因 条件21病理生理学病因（病因（cause）引起疾病，赋予其特异性或决定疾病的性质 生物因素病原微生物和寄生虫，特点是有一定的入 侵门户和定位；病原体和机体相互作用 理化因素 营养因素 （过剩或不足或搭配不当） 遗传因素（基因突变、染色体异常） 先天因素（损害正常胎儿发育的因素） 免疫因素（超敏反应、免疫缺陷病、自身免疫性病） 精神、心理和社会因素22病理生理学条件（condition） 条件：促进/阻止疾病发生发展，不能决定疾病特 异性 诱因（precipitating factor） 危险因素（risk factor）23病理生理学健康健康病因患病患病不利条件不利条件有利条件有利条件（+）（-）24发病学病理生理学发病学（pathogenesis） 研究疾病发生、发展过程中的一般规律和共同机制25病理生理学疾病发生、发展的一般规律 损伤与抗损伤 因果交替 局部和整体相互作用26病理生理学损伤与抗损伤无严格界限、矛盾的两个方面动态变化过程27病理生理学单核吞噬细胞系统物理性屏障应激状态免疫反应炎症凝血化学解毒作用射线微生物异物应激原致热原致畸原致癌原创伤因果交替28病理生理学原始病因原始病因机体适应性改变机体适应性改变机体进一步的改变机体进一步的改变 机体继发性变化机体继发性变化(+)(-)（结果和病因）29大出血大出血心输出量减少心输出量减少血压下降血压下降交感神经兴奋交感神经兴奋微动脉微动脉微静脉微静脉收缩收缩回心血量锐减回心血量锐减微循环淤血微循环淤血毛细血管大量开放毛细血管大量开放组织缺氧组织缺氧环环循循恶恶 性性（病因）（结果和病因）病理生理学因果交替举例局部和整体关系举例 局部影响整体 毛囊炎可引起局部充血、水肿等炎性反应 白细胞升高、发热、寒颤等全身性表现 全身疾病的局部表现 糖尿病患者局部皮肤瘙痒、溃烂，是全身性血糖持续升 高的皮肤毒性反应医务工作者应善于识别局部和整体病变间的主从关 系，抓住主要矛盾进行处理，不能“头疼医头、 脚疼医脚”30病理生理学31神经机制神经机制体液机制体液机制细胞机制细胞机制分子机制分子机制病理生理学疾病发生的基本机制32病因直接损害神经系统机体功能、代谢障碍病因神经系统相应器官，组织功能代谢变化神经递质、体液因子器官，组织功能代谢变化反射内分泌病理生理学神经机制33病因通过体液进行蔓延eg:毒物的损伤作用病 因神经 -体液因子内分泌旁分泌自分泌机体功能、代谢、结构的变化内在分泌病理生理学体液机制34病因细胞膜损伤离子泵功能障碍胞内外离子失衡细胞、组织、器官功能障碍，结构破坏直接损伤细胞病因病因细胞器损伤（线粒体）细胞功能障碍病理生理学细胞机制35疾病的本质是基因及其表达调控的改变疾病信号跨膜信号转导DNAmRNA转录翻译蛋白质分子机体功 能、代 谢