结核-jiaogai.pptVIP

结 核 病 （tuberculosis） 李 波 Department of pathology 1.5 pathogenesis: 1.5.1. Pathogenic materials: 与结核杆菌菌体及细胞壁成分有关 a.lipid:cord factor-破坏线粒体膜;wax D-超敏反应; b.lipoarabinomannan:类似内毒素, 抑制IFN-γ激活巨噬细胞,促进巨噬细胞分泌TNF-α,IL-10; plement:起调理素作用,利于细菌摄入但不能杀死; d.heat-shock protein:高免疫源性蛋白质-自身免疫反应; e.tuberculin protein:具有抗原性-超敏反应; f.caps:与巨噬细胞补体受体CR3结合-细菌识别摄入. 结核杆菌含有脂质、蛋白和多糖类三种成分： ①脂质：特别是糖脂，其衍生物之一称索状因子，使结核杆菌在动物体内具有毒力。另一种糖脂为蜡质D，能引起强烈的变态反应，造成机体的损伤。此外，磷脂还能使炎症灶中的巨噬细胞转变为类上皮细胞，从而形成结核结节。脂质还可保护菌体不易被巨噬细胞消化。 ②蛋白：具有抗原性，与蜡质D结合后能使机体发生变态反应，引起组织坏死和全身中毒症状，并在形成结核结节中发挥一定的作用。 ③多糖类：可引起局部中性粒细胞浸润，并可作为半抗原参与免疫反应。 Pathologic Status of Body Bacillus Pathologic Changes Immune Sensitivity NO. Toxicity Features Exudative Sero-fibrinous Change Weak Stronger Large Strong or Serous Proliferative Tubercle Change Stronger Weaker Little Weaker nodule Necrosis Caseous Change Weak Vehement Large Strong necrosis 2.1 Primary pulmonary tuberculosis first infection by bacilli children occasional youth Different characteristics from primary tuberculosis Constant localization of lesions in the upper part of lung – apical region Proliferative feature– tubercles surrounding caseous necrosis (lesion is localized) Long course and complex pathologic features Primary TB second TB outcome a. therapeutics in time exudate absorbed, necrosis and proliferation lesion fiberocalcified. b. to continue development expanded caseation focus -- liquefiction -- drained off by bronchi –forming acute cavity —— closure chronic cavitation ——chronic fibro-cavitative