組織學(xué)與胚胎學(xué)血液與肌組織課件

血液和血細(xì)胞的發(fā)生Bloodand

Hematopoiesis血液和血細(xì)胞的發(fā)生BloodandHematop1血液Blood血漿plasma:55%紅細(xì)胞

白細(xì)胞

血小板Platelets血漿白細(xì)胞，血小板紅細(xì)胞血細(xì)胞血液不加抗凝劑即凝固成塊，周圍析出的淡黃色清明液體。血清serum:組成:血液Blood血漿白細(xì)胞，血小板紅細(xì)胞血細(xì)胞血液不加2血象

hemogram

定義：是血細(xì)胞形態(tài)、數(shù)量、比例及血紅蛋白含量的測(cè)定。血涂片的常用染色方法是Wright或Giemsa染色。意義：血象的變化是多種疾病診斷、預(yù)后及治療效果的重要指標(biāo)。。血象hemogram定義：是血細(xì)胞形態(tài)、數(shù)量、比例及血3血細(xì)胞

紅細(xì)胞

femal(3.5—5.5)*1012/L

mal（4.0-5.5）*1012/L白細(xì)胞

（4～10）×109/L

血小板（100～300）×109/L

中性粒C

有粒白細(xì)胞嗜酸性粒C

嗜堿性粒C無(wú)粒白細(xì)胞淋巴細(xì)胞

單核細(xì)胞血細(xì)胞紅細(xì)胞中4

紅細(xì)胞erythrocyte,redbloodcell

大?。盒螤睿弘p凹圓盤(pán)狀。結(jié)構(gòu)特點(diǎn)：無(wú)核，無(wú)細(xì)胞器內(nèi)含物：充滿血紅蛋白(Hb)紅細(xì)胞骨架:紅細(xì)胞erythrocyte,redbloodc5HB正常值：血型：血影:HB正常值：6臨床聯(lián)系MedicalApplication

Adecreasednumberoferythrocytesinthebloodisusuallyassociatedwithanemia（貧血）.

Anincreasednumberoferythrocytes(erythrocytosis,orpolycythemia紅細(xì)胞增多癥)maybeaphysiologicadaptation.Polycythemiawhichisoftenassociatedwithdiseasesofvaryingdegreesofseverity,increasesbloodviscosity;Polycythemiamightbebettercharacterizedasanincreasedhematocrit紅細(xì)胞壓積.Erythrocyteswithdiametersgreaterthan9μmarecalledmacrocytes,andthosewithdiameterslessthan6μmarecalledmicrocytes.

臨床聯(lián)系MedicalApplication7網(wǎng)織紅細(xì)胞（reticulocyte)骨髓進(jìn)入血液的未完全成熟的紅細(xì)胞。用煌焦油藍(lán)染色網(wǎng)織紅細(xì)胞內(nèi)有染成藍(lán)色的顆粒或細(xì)網(wǎng)，是殘留的核糖體。網(wǎng)織紅細(xì)胞進(jìn)入外周血1－3天后，核糖體完全消失。網(wǎng)織紅細(xì)胞計(jì)數(shù)常作為判斷骨髓造血能力的重要指標(biāo)。成人0.5％-1％，新生兒高達(dá)3％-6％。人血涂片示網(wǎng)織紅細(xì)胞(煌焦油藍(lán)染色)網(wǎng)織紅細(xì)胞（reticulocyte)骨髓進(jìn)入血液的未完全成8白細(xì)胞

(leukocytes,whitebloodcell,WBC)WBC有粒細(xì)胞無(wú)粒細(xì)胞中性粒細(xì)胞嗜酸性粒細(xì)胞嗜堿性粒細(xì)胞淋巴細(xì)胞單核細(xì)胞

分類依據(jù)：根據(jù)細(xì)胞質(zhì)內(nèi)有無(wú)特殊顆粒和顆粒的嗜色性。白細(xì)胞

(leukocytes,whitebloodc9中性粒細(xì)胞

neutrophil（50%~70%）直徑：細(xì)胞核：胞質(zhì):兩種特殊顆粒

（嗜天青顆粒特殊顆粒）核左移（1-2葉）:核右移（4-5葉）:功能：趨化作用吞噬功能

中性粒細(xì)胞neutrophil（50%~70%）直10嗜酸性粒細(xì)胞eosinophil（0.5%~5%)核多2葉，胞質(zhì)內(nèi)充滿粗大的鮮紅色嗜酸性顆粒，含組胺酶、芳基硫酸酯酶、陽(yáng)離子蛋白、過(guò)氧化物酶等。功能：抑制過(guò)敏反應(yīng),殺滅寄生蟲(chóng)。嗜酸性粒細(xì)胞eosinophil（0.5%~5%)核113.嗜堿性粒細(xì)胞basophil（0~1%）形態(tài)：細(xì)胞質(zhì)：細(xì)胞核功能：與肥大細(xì)胞相似參與過(guò)敏反應(yīng)3.嗜堿性粒細(xì)胞basophil（0~1%）形態(tài)：12

三種有粒白細(xì)胞比較中性粒細(xì)胞嗜酸性粒細(xì)胞嗜堿性粒細(xì)胞直徑細(xì)胞核胞質(zhì)正常值和壽命功能三種有粒白細(xì)胞比較中性粒細(xì)胞嗜酸性粒細(xì)胞嗜堿性粒13

淋巴細(xì)胞lymphocyte（20%~40%)T細(xì)胞B細(xì)胞NK細(xì)胞形態(tài)：胞質(zhì)嗜堿性；核圓形，占細(xì)胞的大部分。根據(jù)發(fā)生部位、表面特征、免疫功能和壽命不同可分類為：分類：淋巴細(xì)胞lymphocyte（20%~40%)14單核細(xì)胞monocyte3%~8%形態(tài)：

細(xì)胞表面微絨毛胞質(zhì)內(nèi)有吞噬泡顆粒有溶酶體樣結(jié)構(gòu)功能：參與免疫單核細(xì)胞monocyte3%~8%形態(tài)：15兩種無(wú)粒白細(xì)胞比較單核細(xì)胞淋巴細(xì)胞大小細(xì)胞核功能兩種無(wú)粒白細(xì)胞比較單核細(xì)胞淋巴細(xì)胞大小細(xì)胞核功能16血小板（LM）Bloodplatelet血小板（EM）Bloodplatelet特殊顆粒、致密顆粒、溶酶體血小板（LM）血小板（EM）特殊顆粒、致密顆粒、溶酶體17血小板platelet功能：止血和凝血.血管受損破裂血栓血小板黏附血塊纖維蛋白原纖維蛋白血小板platelet血管受血栓血小板血塊纖維蛋白原纖維蛋白18臨床聯(lián)系MedicalApplication

Hemophilia（血友?。〢andBareclinicallyidentical,differingonlyinthedeficientfactor.Bothareduetosex-linkedrecessiveinheriteddisorders.Bloodfromhemophiliacpatientsdoesnotcoagulatenormally:Personswiththisdiseasebleedseverelyevenaftermildinjuries,suchasaskincut,andmaybleedtodeathaftermoresevereinjuries.ThebloodplasmaofpatientswithhemophiliaAisdeficientinclottingfactorVIIIorcontainsadefectivefactorVIII;inhemophiliaB,thedefectisinfactorIX.Inseverecasesthebloodisincoagulable.Generally,onlymalesareaffectedbyhemophiliaA,becausetherecessivegenetofactorVIIIisintheXchromosome..FemalesdevelophemophiliaonlywhentheyhavetheabnormalgeneinbothXchromosomes.臨床聯(lián)系MedicalApplication19骨髓和血細(xì)胞發(fā)生造血器官胚胎時(shí)期造血各器官的演變

6W

4-5M

出生后

卵黃囊→→肝→→脾→→骨髓骨髓的結(jié)構(gòu)

紅骨髓：造血組織+血竇黃骨髓:脂肪組織+少量的幼稚血細(xì)胞骨髓和血細(xì)胞發(fā)生造血器官20骨髓光鏡結(jié)構(gòu)造血組織：網(wǎng)狀組織+造血細(xì)胞造血誘導(dǎo)微環(huán)境（hemopoieticinductivemicroenvironment）：

是造血細(xì)胞賴以生長(zhǎng)發(fā)育的環(huán)境。包括：骨髓的神經(jīng)成分、微血管系統(tǒng)和結(jié)締組織。它們不僅起支架作用，還分泌多種細(xì)胞體液因子，調(diào)節(jié)造血細(xì)胞的增殖與分化。造血干細(xì)胞hemopoieticstemcell又稱多能干細(xì)胞（multipotentialstemcell）起源：卵黃囊等處的血島，出生后主要位于紅骨髓、脾和淋巴結(jié)，少量于外周血形態(tài)：類似小淋巴細(xì)胞，即細(xì)胞體積小，核相對(duì)較大，胞質(zhì)富含核糖體特性：①?gòu)?qiáng)增殖潛能②多向分化③自我復(fù)制，終身保持?jǐn)?shù)量恒定。骨髓光鏡結(jié)構(gòu)造血組織：網(wǎng)狀組織+造血細(xì)胞造血干細(xì)胞hemo21

血細(xì)胞發(fā)生圖血細(xì)胞發(fā)生圖22

血細(xì)胞發(fā)生過(guò)程中的形態(tài)演變

原始階段幼稚階段成熟階段。

1.胞體由大到小,巨核細(xì)胞由小到大2.胞核由大到小;紅細(xì)胞核最后消失；粒細(xì)胞核變成桿狀到分葉;巨核細(xì)胞核由小變大到分葉;核著色由淺到深。3.胞質(zhì)量由少漸多,嗜堿性漸變?nèi)?除淋巴細(xì)胞和單核細(xì)胞),出現(xiàn)特殊物質(zhì)。4.細(xì)胞分裂能力從有到無(wú)(淋巴細(xì)胞除外)。血細(xì)胞發(fā)生過(guò)程中的形態(tài)演變

原始階段23臨床聯(lián)系MedicalApplicationGrowthfactorshavebeenusedclinicallytoincreasemarrowcellularityandbloodcellcounts.Theuseofgrowthfactorstostimulatetheproliferationofleukocytesisopeningbroadnewapplicationsforclinicaltherapy.increasingtheefficiencyofmarrowtransplantsbyenhancingcellproliferation;enhancinghostdefensesinpatientswithmalignanciesandinfectiousandimmunodeficientdiseases;andenhancingthetreatmentofparasiticdiseases.Hematopoieticdiseasesareusuallycausedbysuppressionorenhancementofsomeundifferentiatedcellproduction,withaconsequentreductionoroverproductionofhematopoieticcells.Insomediseases,however,suppressionandenhancementofproliferationofmorethanonetypeofstemcellcanoccur,sequentiallyorsimultaneously.臨床聯(lián)系MedicalApplication24肌組織

Muscletissue肌組織

Muscletissue25米?。簲S鐵餅者肌肉組織的分類骨骼肌心肌平滑肌特殊名詞:

1、肌細(xì)胞—肌纖維2、細(xì)胞膜—肌膜3、細(xì)胞質(zhì)—肌漿4、SER—肌漿網(wǎng)米?。簲S鐵餅者肌肉組織的分類骨骼肌特殊名詞:26

骨骼肌光鏡結(jié)構(gòu):胞體：長(zhǎng)圓柱狀，胞核:數(shù)十至數(shù)百個(gè),位周邊胞質(zhì)：充滿肌原纖維，與肌纖維長(zhǎng)軸平行排列，有周期性橫紋骨骼肌光鏡結(jié)構(gòu):27肌節(jié)sarcomere定義:相鄰2條Z線之間的一段肌原纖維，由1/2I帶+A帶+1/2

I

帶構(gòu)成，是骨骼肌纖維結(jié)構(gòu)和功能的基本單位①暗帶（A帶）,中央有H帶,H帶中央有M線②明帶（I帶）,中央為Z線肌節(jié)sarcomere定義:相鄰2條Z線之間的一段肌原纖維28二、骨骼肌纖維的超微結(jié)構(gòu)1、肌原纖維粗肌絲和細(xì)肌絲構(gòu)成；肌原纖維間有肌漿網(wǎng)，大量線粒體、糖原、肌紅蛋白粗肌絲肌球蛋白頭（ATP酶）桿細(xì)肌絲

肌動(dòng)蛋白（肌球蛋白頭部結(jié)合位點(diǎn))原肌球蛋白肌鈣蛋白（可與Ca2+結(jié)合)二、骨骼肌纖維的超微結(jié)構(gòu)1、肌原纖維粗肌絲和細(xì)肌絲構(gòu)成29肌動(dòng)蛋白：兩條相互纏繞串珠狀螺旋鏈組成。原肌球蛋白：雙股螺旋多肽鏈,嵌于肌動(dòng)蛋白雙股螺旋兩側(cè)的淺溝內(nèi)。肌原蛋白：由3個(gè)球形亞單位組成，細(xì)肌絲的分子結(jié)構(gòu)肌動(dòng)蛋白：兩條相互纏繞串珠狀螺旋鏈組成。細(xì)肌絲的分子結(jié)構(gòu)302、橫小管transversetubule位置：明帶、暗帶交處。形成：肌膜凹陷于肌質(zhì)成。功能：傳遞膜電位。肌膜向肌漿內(nèi)凹陷形成的管狀結(jié)構(gòu)，與肌纖維長(zhǎng)軸垂直，同一平面的橫小管分支吻合，環(huán)繞肌原纖維2、橫小管transversetubule位置：明帶、暗313.肌質(zhì)網(wǎng)sarcoplasmicreticulum概念：特化的滑面內(nèi)質(zhì)橫小管之間結(jié)構(gòu)：縱行包繞肌原纖維縱小管扁囊稱終池三聯(lián)體：每條橫小管與兩側(cè)的終池功能：貯存和釋放Ca2+3.肌質(zhì)網(wǎng)sarcoplasmicreticulum概念32肌絲滑動(dòng)原理①運(yùn)動(dòng)神經(jīng)末梢將沖動(dòng)傳遞給肌膜②興奮經(jīng)橫小管傳遞給肌漿網(wǎng)，釋放Ca2+③Ca2+與肌鈣蛋白結(jié)合，使原肌球蛋白和肌鈣蛋白構(gòu)型變化，肌動(dòng)蛋白上的肌球蛋白結(jié)合位點(diǎn)暴露，與肌球蛋白橫橋結(jié)合④ATP被分解釋放能量，橫橋彎，細(xì)肌絲牽向M線⑤細(xì)肌絲向M線滑動(dòng)，明帶、肌節(jié)、肌纖維收縮⑥Ca2+被泵回肌漿網(wǎng)，肌鈣蛋白等復(fù)原，肌纖維松弛肌絲滑動(dòng)原理①運(yùn)動(dòng)神經(jīng)末梢將沖動(dòng)傳遞給肌膜33舒縮時(shí)肌節(jié)的變化

舒縮時(shí)肌節(jié)的變化

34

臨床聯(lián)系Medicalapplication

Thevariationindiameterofskeletalmusclefibersdependsonsuchfactorsasthespecificmuscleandtheageandsex,stateofnutrition,andphysicaltrainingoftheindividual.Itisacommonobservationthatexerciseenlargesthemusculatureanddecreasesfatdepots.Theincreaseinmusclethusobtainediscausedbyformationofnewmyofibrilsandapronouncedgrowthinthediameterofindividualmusclefibers.Thisprocess,characterizedbyaugmentationofcellvolume,iscalledhypertrophy；tissuegrowthbyanincreaseinthenumberofcellsistermedhyperplasia.Hyperplasiadoesnotoccurineitherskeletalorcardiacmusclebutdoestakeplaceinsmoothmuscle,whosecellshavenotlostthecapacitytodividebymitosis.Hyperplasiaisratherfrequentinorganssuchastheuterus,wherebothhyperplasiaandhypertrophyoccurduringpregnancy.臨床聯(lián)系Medicalapplication35臨床聯(lián)系MedicalApplication

Myastheniagravis（重癥肌無(wú)力）isanautoimmunedisordercharacterizedbyprogressivemuscularweaknesscausedbyareductioninthenumberoffunctionallyactiveacetylcholinereceptorsinthesarcolemmaofthemyoneuraljunction.Thisreductioniscausedbycirculatingantibodiesthatbindtotheacetylcholinereceptorsinthejunctionalfoldsandinhibitnormalnerve-musclecommunication.Asthebodyattemptstocorrectthecondition,membranesegmentswithaffectedreceptorsareinternalized,digestedbylysosomes,andreplacedbynewlyformedreceptors.Thesereceptorsareagainmadeunresponsivetoacetylcholinebythesameantibodies,andthediseasefollowsitsprogressivecourse.臨床聯(lián)系MedicalApplication36心肌光鏡結(jié)構(gòu)特點(diǎn)肌纖維短柱狀心肌纖維只有一個(gè)核，位于細(xì)胞中央。心肌纖維之間閏盤(pán)，心肌纖維也有橫紋，不如骨骼肌纖維明顯。心肌光鏡結(jié)構(gòu)特點(diǎn)肌纖維短柱狀37圖17心肌纖維及閏盤(pán)光鏡圖（