病理学（徐长福）损伤修复.pptxVIP

第二章 损伤的修复（tissue repair）;After mild injury, which damages the epithelium but not the underlying tissue, resolution occurs by regeneration, but after more severe injury with damage to the connective tissue, repair is by scar formation. ;Critical to the survival of an organism is the ability to repair the damage caused by toxic insults and inflammation. Repair involves the proliferation of various cells, and close interactions between cells and the extracellular matrix (ECM). ;提 纲;概念：局部组织细胞损失后，由邻近同种细胞通过分裂增殖以完成修复的现象，称为再生（regeneration）。有生理性和病理性再生。 细胞周期及不同细胞的再生潜能 The ability of tissues to repair themselves is critically influenced by their intrinsic proliferative capacity. ;Cell populations and cycle landmarks. Note the cell cycle stages (G0, G1, S, G2 and M), the G1 restriction point, and the G1/S and G2/M checkpoints. ;1. 不稳定组织(labile tissues/Continuously Dividing Tissues.) 随时可从极短的G0期进入细胞周期G1期，不断分裂增殖（又称持续分裂细胞），替代凋亡或损伤细胞。 包括表皮、粘膜被覆上皮，淋巴、造血、间皮细胞等。These tissues can readily regenerate after injury as long as the pool of stem cells is preserved. 2. 稳定组织(stable tissues): 生理状态下不增殖，较长期处在G0期静止状态（又称静止细胞）。一旦同类细胞受损死亡，则可迅速重新进入G1期表现出较强的再生能力。 包括各种腺体和腺样器官的实质细胞、间叶细胞及其分化衍生的各种细胞。;Regeneration of human liver. Computed tomography scans of the donor liver in living-donor liver transplantation. A, The liver of the donor before the operation. Note the right lobe (outline), which will be resected and used as a transplant. B, Scan of the same liver 1 week after resection of the right lobe; note the enlargement of the left lobe (outline) without regrowth of the right lobe. ;3.永久性组织(permanent tissues): 永久性处于G0期静止状态，不再进入下一个细胞增殖周期（故又称非分裂细胞）。包括神经元、心肌和骨骼肌。;各种组织的再生过程 1.上皮组织的再生： 被覆上皮：通过创伤邻近部位的基底层储备细胞及残留细胞分裂增生来完成再生。 腺上皮：BM完整，可完全再生；BM破坏，难以完全再生。 肝细胞再生：部分肝切除后，短期内可完全再生；肝细胞坏死小叶网状支架完整，可完全再生；小叶网状支架塌陷，网状纤维胶原化/肝细胞反复坏死及炎症刺激，纤维增生分隔形成不规则的肝细胞再生结节。; 2.纤维组织的再生： 由成纤维细胞（fibroblast）分裂增殖，分泌前胶原蛋白等细胞外基质成分，并在间质中形成胶原纤维后变为纤维细胞。 3.软骨和骨组织的再生： 软骨再生：软骨膜细胞增生转化为软骨母细胞，分泌软骨基质形成陷窝变为软骨细胞。软骨再生能力弱，缺损较大时纤维组织参与修复。 骨组织再