化生Metaplasia.ppt

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　　Metaplasia is a reversible change in which one adult cell type is replaced by another adult cell type.

　　Metaplasia 化生

　　一种分化成熟的细胞为另一种分化成熟的细胞所替代的过程。 是存在于正常组织中的干细胞或结缔组织中未分化间叶细胞通过增生转变，即重新程序化的结果 化生只出现于具有增生能力的细胞 特异性低的细胞取代特异性高的细胞 化生只发生于同源细胞之间

　　Definition:

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　　Metaplasia-Types

　　Epithelial metaplasia

　　Mesenchymal metaplasia

　　columnar epithelium (trachea, cervix, cholecyst) transitional epithelium (pelvis)

　　Squamous metaplasia 鳞状上皮化生

　　Intestinal metaplasia 肠上皮化生

　　Gastric glandular epithelium

　　Pseudo-pyloric gland Metaplasia 假幽门腺化生

　　corpus and sinus gastric gland

　　Osseous, cartilage and adipose tissue metaplasia 骨、软骨、脂肪组织化生

　　Fibroblasts

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　　Metaplasia-Types

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　　Metaplasia-Types

　　Squamous metaplasia

　　normal

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　　正常气管上皮 鳞状上皮化生

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　　Metaplasia-Types

　　Squamous metaplasia

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　　(Gp:) squamous metaplasia

　　(Gp:) villi of normal trachea

　　Metaplasia-Types

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　　Metaplasia-Types

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　　Advantage

　　loss of normal function Cancer transformation

　　Disadvantage

　　Metaplasia-significance

　　Metaplasia---a “double-edged sword”

　　Defending

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　　atrophy

　　hypertrophy

　　(Gp:) hyperplasia

　　metaplasia

　　adaptation

　　Adaptation

　　Increased demands Growth stimulation

　　Diminished nutrition Low stimulation

　　Chronic stimulation Pathological

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　　第一章

　　Tissue and Cellular Injury

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　　Cell and tissue injury

　　当机体内外环境改变超过组织和细胞的适应能力，引起受损细胞和细胞间质发生物质代谢、组织化学、超微结构乃至光镜和肉眼可见的异常变化，称为损伤

　　Normal cells

　　irreversible injury

　　reversible injury

　　Adaptation

　　(injury)

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　　(Gp:) Hypoxia

　　(Gp:) 1

　　(Gp:) Physical agents

　　(Gp:) 3

　　(Gp:) Biologic agents

　　(Gp:) 4

　　Immunologic reactions

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　　Genetic defects

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　　Nutritional imbalances

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　　Others

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　　(Gp:) 2

　　Chemical agents

　　---Causes

　　Cell and tissue injury

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　　ATP的耗竭(ATP depletion) 线粒体的损伤(Irreversible mitochondria damage ) 膜渗透性的缺陷(Loss of membrane permeability) 细胞内钙的流入和钙内环境稳定的破坏(Overload of intracellular calcium and loss of calcium homeostasis) 氧自由基的集聚(Accumulation of oxygen-derived free radicals)

　　---Mechanisms of cell injury

　　Cell and tissue injury

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　　---Morphologic changes

　　细胞损伤 cellular injury

　　可逆性损伤 reversible injury 变性 Degeneration

　　细胞死亡 cell death

　　不可逆性损伤 irreversible injury

　　坏死 Necrosis 凋亡 apoptosis

　　Cell and tissue injury

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　　Morphologic changes--Reversible injury

　　各种细胞损伤的早期改变为ATP减少、细胞膜完整性缺失、蛋白合成下降、细胞骨架损伤和DNA损伤。在一定限度内损伤的改变为可逆的，传统形态学上称变性(Degeneration)

　　变性指细胞或细胞间质受损伤后，由于代谢障碍，使细胞内或细胞间质内出现异常物质或正常物质异常蓄积的现象，通常伴有细胞功能低下。

　　When cellular injury is sublethal and sustained, cells and tissues tend to accumulate substances in abnormal quantities. These materials may be endogenous or exogenous.

　　Cell and tissue injury

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　　---Morphologic changes

　　(Gp:) 脂质 lipids

　　reversible cell injury

　　(Gp:) 细胞肿胀 Cellular swelling

　　(Gp:) 脂肪变 Fatty change

　　Intra (extra)-cellular accumulations

　　(Gp:) 蛋白质 proteins

　　(Gp:) 淀粉样变 Amyloid change

　　(Gp:) 玻璃样变 hyaline change

　　(Gp:) 黏液样变 mucoid change

　　(Gp:) 病理性色素沉着 Pigments

　　(Gp:) 糖原 glycogen

　　(Gp:) 病理性钙化Pathologic calcification

　　Cell and tissue injury

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　　The common site--- liver, kidney , heart

　　Reversible injury--cellular swelling

　　Cell and tissue injury

　　The commonest and earliest form of cell injury from almost all causes.

　　(Gp:) Hypoxia infection intoxication

　　(Gp:) mitochondria injury

　　(Gp:) ATP↓

　　(Gp:) Na+-K+ pump dysfunction

　　(Gp:) Intracellular accumulation of Na+ and H2O

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　　Reversible injury--cellular swelling

　　Grossly: The affected organ is enlarged due to swelling. The cut surface bulges outwards and is slightly opaque. 肿大，包膜紧张，切面隆起，边缘外翻，混浊无光，如沸水烫过

　　Cell and tissue injury

　　Cellular swelling of liver

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　　Reversible injury--cellular swelling

　　Normal cell Granularity change Hydropic change Viral hepatitis

　　LM: The cells are swollen. Small clear vacuoles are seen in the cells. 病变初期，细胞质内出现的红染细颗粒状物。若水钠进一步 积聚，细胞基质高度疏松呈空泡状，其极期称为气球样变

　　Cell and tissue injury

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　　Reversible injury--cellular swelling

　　Cell and tissue injury

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　　肝细胞水肿(气球样变)

　　Reversible injury--cellular swelling

　　Cell and tissue injury

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　　Hydropic degeneration of renal tubule

　　Reversible injury--cellular swelling

　　Cell and tissue injury

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　　Reversible injury--cellular swelling

　　EM: dilatation of endoplasmic reticulum and mitochondrial swelling 线粒体、内质网肿胀

　　mitochondrial swelling

　　Cell and tissue injury

　　dilatation of endoplasmic reticulum

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　　Reversible injury--cellular swelling

　　肉眼:肿大，包膜紧张，切面隆起，边缘外翻，混浊无光，如沸水烫过 光镜:病变初期，细胞质内出现的红染细颗粒状物。若水钠进一步积聚， 细胞基质高度疏松呈空泡状，其极期称为气球样变 电镜: 线粒体、内质网肿胀

　　Gross: The affected organ is enlarged due to swelling. The cut surface bulges outwards and is slightly opaque. LM: The cells are swollen. Small clear vacuoles in the cells. EM: swelling of endoplasmic reticulum and mitochondria

　　Cell and tissue injury

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　　Definition: The accumulation of fat in non-fatty parenchymal cells.

　　脂肪变: 实质细胞内脂肪的异常蓄积

　　Cell and tissue injury

　　Reversible injury--fatty change

　　Liver, heart, kidneys and other organs

　　肉眼: 器官体积增大，淡黄色，边缘圆钝，切面呈油腻感 光镜: 细胞内出现边缘较整齐的大小不等的圆形空泡， 苏丹Ⅲ呈桔红色，锇酸呈黑色

　　Gross: enlarges, yellow, soft, and greasy. LM: The fatty change appears as clear vacuoles within parenchymal cells.

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　　Fatty change of liver

　　Cell and tissue injury

　　alcohol abuse protein malnutrition obesity hepatotoxin diabetes

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　　Intracellular accumulations ---fatty change

　　Intracellular accumulations ---fatty change

　　Cell and tissue injury

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　　LM: Small vacuoles around nucleus ↓coalesce large vacuoles that displace the nucleus to the periphery of the cell.

　　Fatty change of liver

　　Cell and tissue injury

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　　Special staining Sudan III : orange red Osmic acid: black

　　Fatty change of liver

　　Cell and tissue injury

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　　Fatty change of liver

　　congestion: central parts of the lobules

　　toxication: perilobules

　　Cell and tissue injury

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　　Upper Left: gross appearance. Lower left: HE stain. Upper Right: Sudan III stain for fat. Lower Right: electron microscopy

　　Fatty change of the liver

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　　灶性： 弥慢性: 两侧心室心肌弥漫淡黄色, 见于严重缺氧和中毒 心肌脂肪浸润：心外膜下过多脂肪并向心肌伸入，严重可致猝死

　　部位：左心室的内膜下和乳头肌 肉眼：虎斑心--成排黄色条纹(脂肪变)， 未受 侵犯的心肌(红色) 镜下：脂肪滴较小，串珠状，位于细胞核附近 临床：对心功能一般无大影响

　　Intracellular accumulations ---fatty change of myocardium

　　Cell and tissue injury

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　　Fatty change of myocardium

　　Tiger stripe heart

　　Cell and tissue injury

　　Bands of yellow streaks alternate with red-brown muscle appearance

　　Fatty change are in yellow Myocardium are in red-brown

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　　Special stain Sudan III : orange red Osmic acid: black

　　fatty change of myocardium

　　Cell and tissue injury

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　　Myocardium fatty infiltration

　　Cell and tissue injury

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　　动脉粥样硬化 Atherosclerosis 黄色瘤 Xanthomas 炎症和坏死 inflammation and necrosis

　　Lipid—cholesterol and cholesteryl esters胆固醇和胆固醇酯

　　Cell and tissue injury

　　Atherosclerosis —foam cells

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　　Reabsorbent droplets : renal tubules Russell bodies: plasma cells Defect in protein folding

　　Intra (extra)-cellular accumulations ---Proteins

　　细胞内蛋白积聚，胞质内圆形嗜酸性小滴、空泡或不规则聚集物

　　Cell and tissue injury

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　　Reabsorbent droplets

　　Intracellular accumulations---Proteins

　　Cell and tissue injury

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　　Russell bodies 浆细胞胞浆内可见圆形的嗜伊红小体,将核挤向一侧，是免疫球蛋白蓄积的结果

　　Intracellular accumulations---Proteins

　　Cell and tissue injury

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　　Mallory小体--酒精性肝病时，肝细胞胞质中细胞中间丝前角蛋白变性

　　Intracellular accumulations---Proteins

　　Cell and tissue injury

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　　Various histological or cytological alterations characterized by homogeneous, glasslike eosinophilic appearance in HE stained sections

　　玻璃样变通常用来描述在常规HE切片中细胞内或细胞外组织变成均质、红染、毛玻璃样。又称透明变

　　Definition:

　　Intra(extra)-cellular accumulations --- Hyaline change 玻璃样变

　　Cell and tissue injury

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　　Reabsorb droplets : renal tubules Mallory alcoholic bodies: hepatocytes Russell bodies: plasma cells

　　Hyaline change-Types

　　(Gp:) Intracellular hyaline

　　(Gp:) Arterioles hyaline

　　(Gp:) Collagenous fibrous tissue hyaline

　　Cell and tissue injury

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　　Hyaline change-- Intracellular hyaline

　　Cell and tissue injury

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　　Hypertension and diabetes mellitus Extravasated plasma protein Deposition of basement membrane

　　Hyaline change -- arterioles hyaline细动脉壁玻璃样变

　　Cell and tissue injury

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　　Arterioles hyaline

　　Cell and tissue injury

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　　胶原蛋白交联、变性、融合，增生的胶原纤维增粗，形成均质红染的梁状或片状结构。其间少有血管和纤维细胞

　　Hyaline change ---Collagenous fibrous tissue hyaline 纤维结缔组织玻璃样变

　　Cell and tissue injury

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　　淀粉样变性

　　Amyloid change is a condition that occurs in a group of diseases, all having the localized or generalized deposition of amyloid.

　　指在细胞外间质内出现淀粉样物质的异常沉积

　　病变:镜下细胞外间质呈淡红色的均质状(HE)。因与淀粉遇碘反应相似故得名。刚果红染色呈橘红色 常见部位:细胞间、小血管基底膜、网状纤维支架、血管壁

　　Intra (extra) -cellular accumulations --- Amyloid change(淀粉样变)

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　　Change characterized by accumulation of mucin in intracellular or extracellular loci.

　　指间质内有粘多糖和蛋白质的蓄积

　　Intra(extra) cellular accumulations ---Mucoid change 粘液样变

　　病变: 镜下间质疏松，多突起的星芒纤维细胞散在于灰兰色的粘液样基质中 常见部位:胶原病,如风湿病等,动脉粥样硬化及间叶组织肿瘤基质中

　　Cell and tissue injury

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　　有色物质在细胞内、外的异常蓄积

　　含铁血黄素Hemosiderin 脂褐素Lipofuscin 黑色素Melanin 胆红素bilirubin

　　碳末Carbon 煤尘 smut 纹身色素tattooing

　　Pathologic pigmentation 病理性色素沉着

　　(Gp:) endogenous

　　(Gp:) exogenous

　　Cell and tissue injury

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　　(Gp:) exogenous

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　　Heart failure cell

　　Pathologic pigmentation--Hemosiderin

　　Cell and tissue injury

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　　Pathologic pigmentation--Lipofuscin

　　Cell and tissue injury

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　　Pathologic pigmentation-- Melanin

　　Cell and tissue injury

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　　Pathologic pigmentation-- bilirubin

　　Cell and tissue injury

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　　Pathologic calcification 病理性钙化

　　Types:

　　Definition: Abnormal deposits of calcium salts occur in any tissues except bones and teeth

　　骨、牙之外的组织中固态钙盐沉积

　　钙磷代谢障碍,见于甲状旁腺功能障碍、骨肿瘤、维生素D摄入过多导致高钙

　　继发于局部变性、坏死或其他异物，钙磷代谢正常

　　dystrophic calcification

　　metastatic calcification

　　Cell and tissue injury

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　　Pathologic calcification 病理性钙化

　　Dystrophic calcification

　　Cell and tissue injury

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　　Pathologic calcification 病理性钙化

　　Metastatic calcification

　　Cell and tissue injury

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　　Morphologic changes of tissue and cellular injury

　　(Gp:) 脂质 lipids

　　reversible cell injury

　　(Gp:) 细胞水肿 Cellular swelling

　　(Gp:) 脂肪变 Fatty change

　　Intra (extra)-cellular accumulations

　　(Gp:) 蛋白质 proteins

　　(Gp:) 淀粉样变 Amyloid change

　　(Gp:) 玻璃样变 hyaline change

　　(Gp:) 黏液样变 mucoid change

　　(Gp:) 病理性色素沉着 Pigments

　　(Gp:) 糖原 glycogen

　　(Gp:) 病理性钙化Pathologic calcification

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　　Tissue and Cellular injury

　　irreversible injury

　　Reversible injury

　　Cell death

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　　Irreversible injury --Cell death 细胞死亡

　　Severe damage involve nucleus

　　Function lose

　　Structure destroy

　　Metabolism stop

　　necrosis

　　apoptosis

　　Irreversible injury Cell death

　　Tissue and Cellular injury

　　细胞受到严重损伤累及细胞核时，呈现代谢停止、结构破坏和功能丧失等不可逆性改变即细胞死亡

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　　A sequence of morphologic changes that follow cell death in living tissue.

　　Necrosis 坏死

　　活体内局部组织、细胞的死亡

　　Enzymatic digestion of the cells (autolysis & heterolysis ) Denaturation of proteins

　　The morphologic appearance of necrosis is the result of two essentially concurrent processes:

　　Tissue and Cellular injury

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　　Morphology of necrotic cells

　　(Gp:) Changes in the nucleus

　　(Gp:) 1

　　(Gp:) Karyolysis(核溶解) Pyknosis (核固缩) Karyorrhexis(核碎裂)

　　(Gp:) 2

　　(Gp:) Changes in cytoplasm and cellular membrane

　　(Gp:) Changes in mesenchyma

　　(Gp:) 3

　　(Gp:) Increased Eosinophilia (嗜酸性染色增强): Vacuolated and moth-eaten appearance (虫蚀状或空泡化) cellular membrane breakage—inflammation Calcification (钙化)

　　Tissue and Cellular injury

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　　Morphology of necrotic cells

　　Changes in the nucleus

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　　Karyolysis(核溶解): dissolution of the nucleus (the basophilia of the chromatin fade) Pyknosis (核固缩): nuclear shrinkage and condensation of chromatin (increased basophilia) Karyorrhexis(核碎裂): the pyknotic nucleus fragments

　　normal pyknosis karyorrhexis karyolysis

　　Tissue and Cellular injury

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　　pyknosis karyorrhexis karyolysis

　　Morphology of necrotic cells

　　Tissue and Cellular injury

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　　Cytoplasm: increased eosinophilia loss of RNA and denatured protein

　　Morphology of necrotic cells

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　　坏死的类型 Types of necrosis

　　coagulative necrosis

　　liquefaction necrosis

　　Specialized necrosis

　　necrosis

　　caseous necrosis

　　gangrene

　　fibrnoid necrosis

　　fat necrosis

　　Enzymatic digestion of the cells Denaturation of proteins

　　Tissue and Cellular injury

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　　The necrosis area is swollen, firm and pale. 灰白、干燥、坚实的凝固体，周围见充血出血带，与周围组织界限清楚

　　Coagulative necrosis 凝固性坏死

　　指坏死组织尚保留原组织的细胞轮廓，呈灰白、干燥的凝固状

　　Gross

　　LM:

　　The dead cells preserve their basic structural outline but only indistinctly，appearing as a mass of coagulated pink-staining, homogeneous 细胞微细结构消失，而组织结构轮廓保存

　　Sites:

　　Infarcts of solid organs--heart, spleen, kidney

　　Tissue and Cellular injury

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　　Coagulative necrosis 凝固性坏死

　　Anemic infarct of kidney 肾贫血性梗死 The necrosis area is firm and pale. 灰白、质地较硬的凝固体，充血出血带，与周围组织界限清楚

　　Tissue and Cellular injury

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　　Coagulative necrosis 凝固性坏死

　　Tissue and Cellular injury

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　　coagulative necrosis of heart

　　Tissue and Cellular injury

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　　Liquefactive necrosis 液化性坏死

　　组织坏死因酶性分解而变成液态

　　grossly

　　Soft and liquid. Discharge of the liquid contents forms a cystic space. 坏死组织呈液状,可见坏死腔或软化灶

　　The tissue structure dissolve by enzymes digestion of the cells 原组织结构溶解消失

　　LM:

　　Types:

　　Brain after ischemic injury (rich in lipid) Pancreatitis (rich in protease) Abscesses lytic necrosis

　　Tissue and Cellular injury

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　　Liquefactive necrosis 液化性坏死

　　Tissue and Cellular injury

　　Coagulative necrosis

　　Liquefactive necrosis

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　　Liquefactive necrosis 液化性坏死

　　Tissue and Cellular injury

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　　液化性坏死 - Liquefactive necrosis

　　Liquefactive necrosis of hepatocytes溶解性坏死(lytic necrosis)

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　　Special types of necrosis

　　干酪样坏死 Caseous necrosis 坏疽 Gangrene 脂肪坏死 Fat necrosis 纤维素样坏死 Fibrinoid necrosis

　　Tissue and Cellular injury

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　　Tissue and Cellular injury

　　干酪样坏死 caseous necrosis

　　在结核病时，因病灶中含脂质较多，坏死区呈黄色，状似干酪

　　most often in TB Gross: white or light yellow, cheesy. LM: amorphous granular debris tissue, architecture is completely obliterated

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　　干酪样坏死 caseous necrosis

　　特殊类型的凝固性坏死，肉眼观微黄，质松软、细腻，状似干酪。镜下原有的组织结构完全崩解破坏，呈现一片无定形、颗粒状红染物。主要见于结核病

　　Tissue and Cellular injury

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　　指继发有腐败菌感染的大块组织坏死。

　　Gangrene 坏疽

　　Necrosis of big tissue with secondary putrefactive organisms infection Black and green appearance

　　Gangrene

　　Dry gangrenes Wet gangrene Gas gangrene

　　Tissue and Cellular injury

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　　frostbite injury

　　坏死组织水分少,蒸发 干固皱缩，呈黑褐色，分界明显 四肢末端多见，动脉受阻，静脉通畅 腐败菌感染一般较轻

　　Occurs on the skin surface following arterial obstruction. It is particularly liable to affect the limbs, especially the toes.

　　Tissue and Cellular injury

　　Dry gangrenes

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　　dry, black, clear border with surrounding normal tissue

　　Tissue and Cellular injury

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　　与外界相通的内脏(如肺、肠、子宫、阑尾、胆囊等)或四肢，动脉受阻，静脉也不畅或受阻(淤血，水肿) 坏死组织水分多，局部肿胀、暗绿色、分界不清 腐败菌感染重，产生吲跺，粪臭素、恶臭; 毒素吸收，毒血症

　　Conditions: occurs in naturally moist tissues and organs. Both arterial and venous obstruction; Character: wet swollen, foul-smelling, black or green. Location: small intestine, appendix, lung, uterus, limbs

　　Wet gangrene

　　Tissue and Cellular injury

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　　Wet gangrene

　　Soft, swollen, dark.

　　Tissue and Cellular injury

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　　Gas gangrene

　　深在的开放性创伤合并产气荚膜杆菌感染 坏死组织含大量气体，呈蜂窝状，污秽、暗棕色，捻发感; 战伤，外伤，厌氧菌感染

　　Conditions: deep contaminated wounds in which there is considerable muscle damaged by gas forming bacteria. Character: swollen obviously, gas bubbles formation war wounds

　　Tissue and Cellular injury

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　　Fibrinoid necrosis 纤维素样坏死

　　原因：变态反应性疾病、急进性高血压 部位：结缔组织和血管壁 病变：病变部位形成细丝状、颗粒状或小条块状无结构物质，染色深红，有折光性，由于其与纤维素染色性质相似，故名纤维素样坏死

　　Tissue and Cellular injury

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　　Fat necrosis脂肪坏死

　　酶解性脂肪坏死 外伤性脂肪坏死

　　Tissue and Cellular injury

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　　Fat necrosis脂肪坏死

　　外伤性脂肪坏死

　　Tissue and Cellular injury

　　LM: shadowy outlines of necrotic fat cells, with basophilic calcium deposits and a surrounding inflammation reaction

　　酶解性脂肪坏死

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　　坏死的类型 Types of necrosis

　　coagulative necrosis

　　liquefaction necrosis

　　Specialized necrosis

　　necrosis

　　caseous necrosis

　　gangrene

　　fibrnoid necrosis

　　fat necrosis

　　Enzymatic digestion of the cells Denaturation of proteins

　　Tissue and Cellular injury

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　　溶解和吸收 Lysis and absorption 分离排出 Isolation and discharge 机化和包裹 Organization 钙化 Encapsulation calcification

　　生理上的重要性 Physiologic importance 坏死细胞数量 Amount of necrotic cells 细胞再生能力 Ability of cells 器官代偿能力 Compensatory capacity

　　Tissue and Cellular injury

　　坏死对机体的影响

　　坏死结局

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　　淋巴管，血管 巨噬细胞

　　Tissue and Cellular injury

　　Sequel of necrosis -- Lysis and absorption

　　引起急性炎症(与死后自溶区别) 蛋白水解酶→溶解液化

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　　形成缺损 糜烂：皮肤粘膜处浅表性坏死缺损 溃疡：皮肤粘膜处较深的坏死性缺损 窦道：由于坏死形成的开口于表面的深在性盲管 瘘管：两端开口的通道样缺损 空洞：坏死物质溶解后经由自然管道排出后残留的空腔

　　Sequel of necrosis -- Isolation and discharge

　　Tissue and Cellular injury

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　　Ulcer & erosion

　　Sequel of necrosis -- Isolation and discharge

　　Tissue and Cellular injury

　　ulcer

　　cavity

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　　腕关节窦道

　　瘘管(肛周围脓肿)

　　Sequel of necrosis -- Isolation and discharge

　　Tissue and Cellular injury

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　　机化：由肉芽组织取代坏死组织、纤维素性渗出物、浓缩的脓液、组织内血肿和血栓等无生机物质的过程。

　　Sequel of necrosis-- Organization

　　Tissue and Cellular injury

　　necrosis

　　Granulation tissue

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　　当坏死灶较大，或坏死物难以溶解吸收，或不能完全机化时，则常由周围肉芽组织加以包裹，以后则为增生的纤维组织包裹

　　Sequel of necrosis-- Encapsulation

　　Tissue and Cellular injury

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　　凋亡 Apoptosis

　　凋亡是活体内个别细胞程序性细胞死亡(programmed cell death)的表现形式，是由体内外因素触发细胞内预存的死亡程序而导致的细胞主动性死亡方式，在形态和生化特征上都有别于坏死。 是正常细胞群体中单个细胞的死亡。

　　A single cell death in living bodies controlled by the genes which is a energy-dependent suicide process.

　　1972, “falling off” A form of cell death A way to eliminate unwanted host cells through activation of a coordinated, internally programmed series of events

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　　Difference between apoptosis and necrosis

　　凋亡 Apoptosis

　　Cell shrinkage Chromatin condensation nucleus fragments Formation of cytoplasmic blebs and apoptotic bodies Phagocytosis of apoptotic cells or bodies No inflammation

　　Apoptosis

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　　Morphological changes

　　凋亡 Apoptosis

　　LM: Single cells or small clusters of cells Round or oval mass of eosinophilic cytoplasm with dense nuclear chromatin fragments 凋亡小体多呈圆形或卵圆形，大小不等，胞浆浓缩，强嗜酸性，核染色质浓集呈紫蓝色致密的球状

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　　电镜：凋亡细胞皱缩，质膜完整，胞浆致密，细胞器密集伴不同程度退变。核染色质致密，形成形态不一、大小不等的团块边集于核膜处，进而胞浆裂解，形成凋亡小体

　　凋亡 Apoptosis

　　Morphological changes

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　　凋亡 Apoptosis

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　　光镜：凋亡细胞;末端标记(TUNEL)　　 电镜：凋亡小体 生化：caspases酶激活，梯状DNA 流式细胞仪：亚二倍体峰

　　凋亡的检测方法

　　凋亡 Apoptosis

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　　生理：平衡细胞的增殖与清除 正常器官的大小和功能 参与胚胎时期器官的形成与发育 生理性萎缩 急性炎症时中性粒细胞和免疫反应后的淋巴细胞

　　凋亡的意义

　　凋亡 Apoptosis

　　病理： 肿瘤 病毒性感染 病理性萎缩

　　凋亡失衡

　　凋亡不足 肿瘤 自身免疫性疾病

　　凋亡过多 神经变性性疾病 缺血性疾病

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　　凋亡 Apoptosis