最新多灶性脉络膜炎伴全葡萄膜炎幻灯片.ppt

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1、多灶性脉络膜炎伴全葡萄膜炎弥散性血管内凝血Chapter11中山医学院病理生理教研室邓宇斌DIC一、DIC原因和发病机制二、促进DIC发生发展的因素（诱发困素）三、DIC的分期和分型四、DIC的功能代谢变化（病理生理变化）五、DIC防治的病理生理基础第一节概述1.血液的凝固与抗凝流动性血液运输载体方向性内（Ⅻ）凝血系统凝血外（Ⅲ）血小板：粘聚释凝↑／抗凝↓→栓塞失衡凝↓／抗凝↑→出血倾向2.DIC的概念出血病因微血栓后休克致凝继发纤溶亢进果栓塞溶血>120种病：感染、肿瘤、产科意外IntroductionDICischaracterizedbytheactivati

2、onofthecoagulationsystemwithresultantconsumptionofavarietyofcoagulationproteinsandplatelets,whichresultsinhemorrhagicdiathesisandischemicinjurytovarioustissues.1.BloodCoagulationItispropagatedbyanenzymaticeventstermedcoagulationcascade.ContactfactorsandtheintrinsicpathwayTissuefactoran

3、dextrinsicpathway2.FibrinolysisItistheresultoftheactionofplasmin,aproteolyticenzymeproducedfromaninertplasmaprecursor(plasminogen)bytheactionofvarioussubstancestermedplasminogenactivators.HumoralplasminogenactivatorsTissueplasminogenactivatorsFibrinorfibrinogendegradationproductsFDP(Si

4、gnificantbiologicalactivity)FragmentsX,YandE(potentantithrombins)FragmentsYandD(inhibitfibrinpolymerization)ⅡaⅡaⅢaPCAPCTM+Ⅱ灭活PS(+)C4bC4bPS(-)酶纤溶FDP酶ATPC抗APCTM+Ⅱa凝PSPGI2VECTM第二节DIC的病因发病学一、发病原因及机理1.VEC广泛受损⑴原因感染炎症、免疫损伤（抗磷脂综合征）高低温、放射损伤缺血缺氧酸中毒EtiologyofDIC1.acuteDIC(1)septicemia(2)severetra

5、uma(3)obstetricaccidents(4)shock2.subacuteDIC(1)malignanttumors(2)retaineddeadfetus3.chronicDIC(1)gianthemangioma(2)systemiclupuserythematosus(SLE)⑵机理胶原暴露凝↑VEC释放Ⅲ受损合成PGI2↓→TXA2↑抗凝↓表达TM↓→APC↓2.血细胞大量受损⑴RBC受损感染：疟疾原因：溶血G6PDase↓：蚕豆病免疫损伤：异型输血红细胞素（Ⅲ）机理：释ADP→P聚集⑵WBC激活或受损坏死白血病细胞→释Ⅲ原因化疗受损机理炎症激活→

6、合成、释Ⅲ（内毒素、补体、LC、P、Ag－Ab）⑶P激活或受损原发性：免疫损伤（抗P抗体抗磷脂抗体）继发性：DIC粘（GPⅠb－胶原）聚（GPⅡb／Ⅲa－fg）TXA2等P聚、血管收缩机理PF1～11提供“反应面”ⅩⅡⅨa－Ca2+－ⅧaⅩa－Ca2+－ⅡaPF3PF33.大量致凝物质入血肿瘤细胞⑴Ⅲ坏死（包括产科意外）组织细胞⑵带负电颗粒物质（内毒素）→Ⅻa胰蛋白酶⑶其它丝氨酸蛋白水解酶→Ⅱa蝰蛇毒PathogenesisofDIC1.extensivedamageofvascularendothelialcellsIntrinsicclottingcascade

7、2.severetissueinjuryExtrinsicclottingreaction3.excessivedestructionofthecirculatingbloodcellsGenerationofprocoagulant-activesubstancesIntravascularcoagulation4.otherthromboplasticmaterialsenteringthebloodActivationofclottingsystemthroughthecontactofbloodwithanabnormalsurfacetheneteff