(精编)【医学教学课件大全】阻塞性肺疾總論與慢性阻塞性肺疾病(慢阻肺)(86p).pptVIP

CHAPTER 4: PATHOLOGY, PATHOGENESIS, AND PATHOPHYSIOLOGY GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE GLOBAL STRATEGY FOR THE DIAGNOSIS, MANAGEMENT, AND PREVENTION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE (2006) 內容 COPD 定義與分類 病變的解剖位置 病理生理 GINA GOLD 區域 1 ：慢性支氣管炎，無氣流阻塞。 區域 2 ：肺氣腫，無氣流阻塞。 區域 3 ：慢性支氣管炎，併有氣流阻塞(COPD)。 區域 4 ：肺氣腫，併有氣流阻塞 (COPD)。 區域 5 ：慢性支氣管炎，併有肺氣腫及氣流阻塞 (COPD)。 區域 6 ：慢性支氣管炎，併有可部份恢復之氣流阻塞 (COPD)。 區域 7 ：肺氣腫，併有可部份恢復之氣流阻塞 (COPD)。 區域 8 ：慢性支氣管炎，併有肺氣腫及可部份恢復之氣流阻塞(COPD)。 區域 9 ：可完全恢復之氣流阻塞 (asthma)。 區域10：氣流阻塞，係肇因於已知病因或特殊病理變化，例如：支氣管擴張症，或阻塞性細支氣管炎。 區域11：慢性支氣管炎，併有肺氣腫，並無氣流阻塞。? / centriacinar emphysema 肺氣腫在病理學上可分為三類： 1.腺泡中央型肺氣腫(centriacinar emphysema)：氣道擴大起自呼吸性細支氣管向周圍散佈，主犯上肺野，好犯於吸菸者。2.全腺泡型肺氣腫(panacinar emphysema)：侵犯整個肺泡，主犯下肺野，好發於同基因型ATT缺乏症患者。3.腺泡遠端型肺氣腫(distal acinar emphysema)：病灶主要集中於肺小葉纖維中隔或肋膜旁，有時會造成氣胸 慢性支氣管炎之病理特徵為支氣管黏液腺肥大併腺體管道擴張，有時可見杯狀細胞增生與支氣管壁平滑肌肥大。 Hypothetical tracking curves of FEV1 for individuals throughout their lifespans. The normal pattern of growth and decline with age is shown by curve A. Significantly reduced FEV1 (65% of predicted value at age 20) can develop from a normal rate of decline after a reduced pulmonary function growth phase (curve B), early initiation of pulmonary function decline after normal growth (curve C), or accelerated decline after normal growth (curve D). (From B Rijcken: Doctoral dissertation, p 133, University of Groningen, 1991; with permission.) Distributions of forced expiratory volume in 1 s (FEV1) values in a general population sample, stratified by pack-years of smoking. Means, medians, and ± 1 standard deviation of percent predicted FEV1 are shown for each smoking group. Although a dose-response relationship between smoking intensity and FEV1 was found, marked variability in pulmonary function was observed among subjects with similar smoking histories. (From Burrows et al, with permission.) Pathogenesis of emphysema. Upon long-term exposure to cigarette smoke, inflammatory cells are recruited to the lung; they rele