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1、损伤的修复,损伤(injury)缺损(defect)修复(repair),修复(repair),机体对损伤所形成缺损进行修补恢复的过程。 Repair is a response to tissue injury and the process to restore integrity to an injured tissue by the organism.,问题与启迪(questions),什么是瘢痕? 瘢痕是怎样形成的? 能不能不形成瘢痕? 瘢痕形成有正面意义吗? 能否加速伤口愈合? 伤口愈合不佳的原因有哪些?,修复形式(Types of repair),1.再生(regeneratio
2、n):同种组织完全再生Repair by same tissue 2.纤维性修复(fibrous repair) 纤维结缔组织修复Replacement by fibrous tissue,第一节 再生 (Regeneration),P27,定义:由损伤部周围的同种细胞来修复,称为再生(regeneration) Repair by cells of same type 特点:完全恢复原组织的结构及功能,Whats regeneration?,一 组织的再生能力 (Regenerative potentials of tissues),低等动物 高等动物 分化低 分化高 易受损伤和常更新组织再
3、生能力强 取决于动物的种类和组织分化能力 生物进化(evolution),一 细胞再生能力分类(Types),1.不稳定细胞(labile cells) 强再生能力;表皮,粘膜上皮,间皮,淋巴及造血细胞 Continuously dividing and dying Covering epithelia Hematopoietic cells(the bone marrow cells and the lymphoid cells),2.稳定细胞(stable cells),较强再生能力, 肝,胰,肾,腺体,平滑肌,原始间叶细胞及其分化细胞(纤维母,软骨,骨母) Quiescent but c
4、an rapidly divide in response to injury Parenchymal of solid glandular tissues: liver, kidney, pancreas, gland Endothelial cells Connective tissue (fibroblast, osteoblasts) Smooth muscle,3.永久性细胞(permanent cells),微弱或无再生能力; 神经元,骨骼肌,心肌细胞 Be terminally differentiated and nonproliferative after the growt
5、h early in life Nerve cells(neuron), striated and cardiac muscle cells,1. Labile cells: continuouslydividing cells,2. Stable cells: quiescent cells that divide only when needed,3. Permanent cells: nondividing cellsthat permanently removed from cell cycle,小结(Summary):细胞再生力分类,二 组织的再生过程(Regeneration of
6、 various tissues),1被覆上皮(covering epithelia)基底细胞分裂增生,2腺上皮(glandular epithelia)BM未破坏完全再生BM破坏不完全再生(reticulin scaffold ),Regeneration of various tissues,3.血管(blood vessel) 小血管及毛细血管内皮出芽(sprout) -实性条索血流冲击-形成管腔(canalization) 大血管内皮(endothelial cells )-完全再生肌层(smooth muscles):-疤痕修复,Regeneration of various tis
7、sues,4.神经组织(nervous tissue) (1)脑及脊髓神经细胞(nerve cell)胶质瘢痕(glial scar) 新知识点:可再生!,4.神经组织(nervous tissue),(2)外周神经(peripheral nerve) 可完全再生 髓鞘及轴突崩解 神经鞘细胞增生 轴突延长 1mm/Day,创伤性神经瘤,Traumatic neuroma,三 细胞再生的分子机制,1.干细胞(stem cell) 具有自我更新和分化潜能的未分化细胞 自我更新(Self-renewal) 分化潜能(Differentiation) 不对称复制(asymmetric replicat
8、ion) 前体细胞/特化细胞precursors/specialized cell,新概念: 再生医学,Regenerative Medicine 胚胎干细胞(Embryonic stem cells, ESC) : pluripotent cells Therapeutic cloning,成体干细胞(Adult Stem cells, ASC) :More restricted differentiation capacity Bone Marrow Haematopoietic stem cells,新概念: 再生医学,新概念: 再生医学,诱导性多能干细胞(iPSC)(induced p
9、luripotent stem cells) :已分化成体细胞的重新编程,细胞再生与分化的分子机制,2.细胞外基质(ECM)(Extracellular Matrix)胶原纤维,弹力纤维,粘附蛋白,蛋白多糖, 3.信号转导(Signal transduction) 4.细胞因子/生长因子(Cytokine/growth factor),Growth factors & cytokines,PDGF-platelet derived growth factor FGF-fibroblast growth factor EGF-epidermal growth factor TGF-transfo
10、rming growth factor VEGF-vascular endothelial growth factor NGF- nerve growth factor HGF-hepatocyte growth factor TNF-tumor necrosis factor IL-1interleukin-1(白细胞介素-1),细胞再生与分化的分子机制,5.接触抑制(contact inhibition) 6.抑素(chalone) 7.基因调控(gene regulation)原癌基因(proto-oncogene)细胞周期基因(cell division cycle genes, CD
11、C genes),第二节 纤维性修复(Fibrous repair),P36,纤维性修复,瘢痕修复(Scar repair) 再生能力弱或缺乏再生能力的组织(less regeneration capacity); 无原组织的结构及功能 不完全修复(incomplete repair),纤维性修复特点 Features of fibrous repair,肉芽组织(granulation tissue),pink, soft, wet and granular,一 肉芽组织(granulation tissue),由新生的毛细血管、增生的纤维母细胞和各种炎性细胞组成,呈鲜红色,颗粒状,柔软湿润
12、,形似鲜嫩的肉芽 Fibroblasts and new capillaries in a loose extracellular matrix.,Granulation tissue: morphology,新生毛细血管,垂直于创面 Richly capillary sprouts 纤维母,肌纤维母细胞 Reactive fibroblasts and myofibroblasts 炎细胞:中性粒,巨噬,淋巴细胞 Variable numbers of inflammatory cells,Granulation tissue: function,抗感染及保护创面Anti-infection
13、 and protect the wound surface 填补伤口及组织缺损To make up the deficiency and repair the injured tissue 机化或包裹坏死、血栓、炎症渗出物及异物To organize blood clotting, necrotic tissues or abnormal substances转化 疤痕组织(scar),二 瘢痕组织(scar tissue),瘢痕组织是肉芽组织逐渐成熟(纤维化)并老化(玻璃样变)的纤维结缔组织。 Fibrosis/maturation and retrogradation of granul
14、ation tissue Pale-gray, hard, lack of elasticity, tissue shrinkage,瘢痕组织形态(morphology),毛细血管退化消失(blood capillary) 纤维母细胞/纤维细胞稀少(fibroblasts) 炎细胞消失(inflammatory cells) 胶原纤维大量平行交错(collagen synthesis) 间质致密玻璃样变(hyaline change),瘢痕组织的作用(function),有利(advantages)填补创伤缺损,保持组织器官完整性Integrity: fill the defect and r
15、epair the tissue瘢痕中胶原纤维具有一定抗拉力,保持组织的坚固性。Firmness: more tensile strength,Complications of Scar -Excessive scar formation,不利(disadvantages) 瘢痕收缩(Scar contractures):关节挛缩(joint contracture),瘢痕粘连(Adhesions): 肠粘连,器官硬化(Sclerosis): 肺纤维化,Complications of Scar,肥大性瘢痕(Hypertrophic Scar):,瘢痕疙瘩(keloid) 蟹足肿(cheloi
16、d),瘢痕体质 (genetic predisposition) III型胶原(Deposition of Type III collagen),Complications of Scar,第三节 创 伤 愈 合 (Wound healing),P40,创伤愈合(wound healing) 是指机体遭受外力作用,皮肤等组织出现离断或缺损后的愈复过程。 A complex but orderly process, involving both parenchymal cells regeneration and the formation of connective tissue scar.,Whats wound healing?,一 创伤愈合的基本过程 (Basic process of wound healing),1.伤口早期变化(exudate) 2.伤口收缩(contraction of the wound):2-3d 3.肉芽组织和瘢痕形成(granulation & mature) 4.表皮等组织再生(regeneration),