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1 心血管系统疾病 Cardiovascular System

2 风湿一词起源于古希腊公元前 4 世纪希波克拉底全集有关人体解剖一文中认为 : 人体的体液由于湿冷而下注于四肢内脏引起疾病, 即为风湿公元前 5 世纪黄帝内经风寒湿三气杂合为痹

3 风湿病 (Rheumatism) 一概述 1 与 A 组乙 (β) 型溶血性链球菌感染有关 2 主要侵犯 CT 3 变态反应- 自身免疫性疾病

5 床指导意二病因与发病机制 ( 一 ) 病因 ( 二 ) 发病机制临1 抗感染 ; 义2 急性期用激素 ; 3 辅助诊断

6 三基本病理变化 1 变质渗出期 [ 约持续 1 个月 ] (1) 变质粘液样变和纤维素样坏死 (2) 渗出 1 液体 : 浆液纤维素渗出 2 细胞 : 少量 L P E 和 N

7 环形红斑 (erythema annullare) erythema annulare

8 三基本病理变化 2 增生期或肉芽肿期 [ 约 2~3 月 ] 特征性病变 : 风湿肉芽肿风湿小体阿少夫小体 (Aschoff body) (granulomatous phase)

9 2 增生期或肉芽肿期 [ 约 2~3 月 ] (granulomatous phase) 风湿肉芽肿 (1) 好发部位 : 心肌间质, 血管旁, 心内膜下, 皮下结缔组织

10 2 增生期或肉芽肿期 [ 约 2~3 月 ] (granulomatous phase) 风湿肉芽肿 (1) 好发部位 (2) 病变 1 肉眼 : 数个细胞 ~ 约 1 cm, 2 组成 : 呈球形椭圆形或梭形

淋巴细胞浆细胞成纤维细胞 2 组成 : 纤维素样坏风湿 C Aschoff giant cell Here

The most characteristic component is the Aschoff giant

11 淋巴细胞浆细胞成纤维细胞 2 组成 : 纤维素样坏风湿 C Aschoff giant cell Here is an Aschoff nodule at high magnification. The most characteristic component is the Aschoff giant cell. Several appear here as large cells with two or more nuclei that have prominent nucleoli. Scattered inflammatory cells accompany them and can be mononuclears or occasionally neutrophils

12 Another peculiar cell seen with acute rheumatic carditis is the Anitschkow myocyte. This is a long, thin cell with an elongated nucleus.

13 2 增生期或肉芽肿期 [ 约 2~3 月 ] (granulomatous phase) 风湿肉芽肿 (1) 好发部位 (2) 病变 (3) 意义 1 是风湿病的特征性病变, 对风湿病有诊断意义 ; 2 提示风湿活动

14 三基本病理变化 3 纤维化期或愈合期 [ 持续 2-3 个月 ] : (1) 纤维素样坏死物被溶解吸收 ; (2) 梭形小瘢痕

15 皮下结节 (subcutaneous nodules)

16 四风湿病的各个器官病变 1 风湿性关节炎(rheumatic arthritis) (1) 好发年龄 : 成年 ; (2) 好发部位 : 膝肩腕髋等大关节 (3) 临床特征 : 游走性多关节炎 ; (4) 病变特点 : 风湿性关节炎病变消退后, 不遗留关节变形 ( 风湿病是舔过关节, 咬住心脏

17 ( 一 ) 其它器官的风湿病变 1 风湿性关节炎 (rheumatic arthritis) 2 皮肤病变环形红斑 (erythema annullare) 皮下结节 (subcutaneous nodules)

18 ( 一 ) 其它器官的风湿病变 1 风湿性关节炎(rheumatic arthritis) 2 皮肤病变 3 风湿性脑病小舞蹈症 (chorea minor)

19 ( 二 ) 风湿性心脏病 (rheumatic heart disease,rhd)

20 1 风湿性心外膜炎 (rheumatic pericarditis) fibrinous or erofibrinous exudate can not be resolve Organization result in scarring and adhesion Constrictive pericarditis adherent pericardium cor villosum Constrictive pericarditis

21 2 风湿性心肌炎 (rheumatic myocarditis) (1) 部位 : 室间隔和左室后壁上部 > 左室后乳头肌, 左房后壁及心耳 (2) 病变 : 特征性 : 风湿小体 ( 心肌间质内小血管附近 )

22 rheumatic endocarditis

23 3 风湿性心内膜炎 (rheumatic endocarditis) (1) 部位 : 二尖瓣 > 二尖瓣 + 主动脉瓣

24 3 风湿性心内膜炎 (rheumatic endocarditis) (2) 病变 : 疣状赘生物 (vegetations) 1 粟粒大小 (1-3mm), 灰白色, 半透明, 串珠状单行排列于瓣膜闭锁缘 ; 2 与瓣膜粘连紧密, 不易脱落

25 Subacute Infective Endocarditis

28 3 风湿性心内膜炎 (rheumatic endocarditis) (2) 病变 : 疣状赘生物 (vegetations) (3) 结局 : 瓣膜病

29 valvular vitium of the heart

30 心瓣膜病 (valvular vitium of the heart) 是最常见的慢性心脏病之一一概念 : 是指心瓣膜因先天性发育异常或后天性疾病造成的器质性病变表现 : 瓣膜口狭窄和 ( 或 ) 关闭不全

31 二病因风湿性心内膜炎 SBE 主动脉炎 ( 梅毒 )

32 三瓣膜变形表现 1 瓣膜关闭不全 2 瓣膜口狭窄 3 联合瓣膜病

33 四二尖瓣狭窄 (mitral stenosis) 正常成人二尖瓣口面积 : 约为 5 cm 2, 可通过两个手指 1 分度( 面积缩小情况 ): 轻度 :1.5 ~2.0 cm 2 ; 中度 :1.0 ~1.5 cm 2 ; 重度 : <1.0 cm 2 2 分型 (1) 隔膜型 ( 早期 ) (2) 漏斗型 ( 后期 ) 鱼口状

34 3 血流动力学及临床病理联系

35 3 血流动力学及临床病理联系

36 右心肥大扩张右心衰全身淤血 ( 颈 V 怒张肥大 ) 3 血流动力学及临床病理联系二尖瓣狭窄 ( 为例 )( 心尖区隆隆样舒张期杂音 ) 左房流入左室受阻左房容量负荷增加左房扩张, 肥大衰竭 (X-ray: 左房大左室正常食管右移 ) 肺淤血水肿出血 ( 呼吸困难发绀咯血 ) 肺小 A 痉挛, 硬化肺 A 高压正常 : 15mmHg, 2Kpa 增高 : 40-50mmHg, Kpa

37 谢谢!

38 动脉粥样硬化 (Atherosclerosis,AS)

39 概述 1 病因: 与脂质代谢障碍有关 ; 2 部位: 大中型动脉 ; 3 病变: 脂质沉着, 形成粥样硬化斑块为特征 ; 4 年龄: 中老年人 ; 5 后果: 心脑缺血性改变 ;

40 一病因和发病机制 ( 一 ) 危险因素高脂血症 HBP 吸烟糖尿病

41 ( 二 ) 发病机制

42 二病理变化 ( 一 ) 病变部位 (1) 大 A( 弹力型 A) 胸主 A 腹主 A (2) 中 A( 弹力 - 肌型 A) 冠状 A 脑底 A 肾 A 四肢 A

43 ( 二 ) 基本病变 1. 脂纹光镜 : 较多泡沫细胞大体 : 黄色斑点 / 条纹

44 ( 二 ) 基本病变 2. 纤维斑块大体 : 灰黄 / 灰白纤维素斑块隆起于内膜, 似蜡滴

45 纤维斑块病变正常主动脉

46 ( 二 ) 基本病变 2. 纤维斑块光镜 : 表面 : 纤维帽其下 :smc,mφ, 泡沫细胞

47 表面为玻璃样变性的纤维结缔组织帽 (S), 内膜中形成粥肿, 其中为大量胆固醇结晶析出和坏死物质

48 ( 二 ) 基本病变 3. 粥样斑块 or 粥瘤大体 : 表面 : 灰黄色斑块, 切面 : 表层为 FCT 帽, 瓷白深部为多量黄色粥糜样物

49 腹主动脉内膜不平, 可见大小不一的黄色隆起斑块, 表面粗糙, 并有溃疡形成 ( )

50 Three aortas are shown to demonstrate mild, moderate, and severe atherosclerosis from bottom to top

51 ( 二 ) 基本病变 3. 粥样斑块 or 粥瘤光镜 : 纤维帽胆固醇结晶等肉芽组织 L.C 泡沫细胞钙化

52 The cholesterol clefts of lipid, along with a few scattered foam cells and a couple of lymphocytes, are seen at high magnification in this atheromatous plaque.

53 ( 二 ) 基本病变 4. 继发性病变斑块内出血斑块破裂血栓形成钙化动脉瘤 aneurysm

54 粥样硬化斑块溃疡形成

55 腹主动脉髂动脉血栓形成

56 动脉瘤

57 ( 三 ) 主要动脉的病变主动脉冠状动脉脑动脉其它

58 动脉粥样硬化的纤维斑块病变正常主动脉

59 基底动脉环硬化

60 基底动脉环硬化基底动脉内血栓形成

61 This is cerebral atrophy. The gyri are narrowed and the sulci widened toward to frontal pole.

62 足干性坏疽

63 左旋支

64 第二节冠状动脉 AS 1 好发于冠状 A 的原因 (1) 冠状 A 与主 A 垂直 ( 冲击力大 ) (2) 冠状 A 直接从血液中吸取营养 (3) 血栓素 A2 冠状 A 痉挛

65 第二节冠状动脉 AS 1 好发于冠状 A 的原因 : 2 好发部位: (1) 左前降支 : 心尖部左室前壁室间隔前 2/3 (2) 右冠状 A: 右室大部分左室后壁室间隔后 1/3 (3) 左旋支 : 左室侧壁

66 左冠状动脉右冠状动脉

67 3 病变半月形增厚, 偏心性狭窄

68 半月形增厚, 偏心性狭窄

69 3 病变 (1) 肉眼 : 半月形增厚, 偏心性狭窄弯曲增厚变硬 ; 黄色斑块

70 This is mild coronary atherosclerosis. A few scattered yellow lipid plaques are seen on the intimal surface of the opened coronary artery traversing the epicardial surface of a heart. The degree of atherosclerosis here is not significant enough to cause disease, but could be the harbinger of worse

71 This is coronary thrombosis, one of the complications of atherosclerosis. The dark red thrombus is seen in the anterior descending coronary artery.

72 This is the gross appearance of severe coronary atherosclerosis, which involves virtually 100% of the surface of the coronary. There is extensive calcification, especially at the right where the lumen is narrowed.

73 Here is a coronary artery with atherosclerotic plaques. There is hemorrhage into the plaque in the middle of this photograph. This is one of the complications of atherosclerosis. Such hemorrhage could acutely narrow the lumen.

74 ere is the coronary thrombosis at higher magnification. The thrombus occludes he lumen and produces ischemia and/or infarction of the myocardium.

75 3 病变半月形增厚, 偏心性狭窄 (1) 肉眼 : (2) 光镜 1 内膜半月形增厚, 管腔偏心性狭窄 2 可有继发改变 : 机化再通钙化出血

76 This is a normal coronary artery. The lumen is large, without any narrowing by atheromatous plaque. The muscular arterial wall is of normal proportion.

77 Here is occlusive coronary atherosclerosis. The coronary at the left is narrowed by 60 to 70%. The coronary at the right is even worse with evidence for previous thrombosis with organization of the thrombus and recanalization such that there are three small lumens remaining.

78 This is an atheromatous plaque in a coronary artery that shows endothelial denudation with disruption and overlying thrombus formation at the right.

79 A coronary thrombosis is seen microscopically occluding the remaining small lumen of this coronary artery.

80 冠状动脉硬化区

81 冠状动脉近端狭窄冠状动脉远端闭塞

83 第二节冠状动脉 AS 1 好发于冠状 A 的原因 2 好发部位 3 病变 4 影响

84 冠状动脉性心脏病 (coronary heart disease,cdh ) 狭窄性冠状 A 疾病 ( 冠状 A 粥样硬化 ) 缺血性心脏病目前认为是人类死亡主要疾病第一杀手

85 冠状动脉性心脏病 (coronary heart disease,cdh ) 冠心病在祖国医学内经中就有记载 : 真心痛, 手足青至节, 心痛甚, 旦发夕死, 夕发旦死

86 冠心病主要分为三型心绞痛心肌梗死心肌硬化

87 (1) 心绞痛 (angina pectoris) 1 定义是冠状动脉供血不足和 ( 或 ) 心肌耗氧量骤增致使心肌急剧的暂时性缺血缺氧所引起的临床综合征

88 (1) 心绞痛 (angina pectoris) 2 表现阵发心前区痛, 紧迫感, 放射左肩 / 左臂, 每次发作仅持续几秒 ~ 几分硝酸甘油可缓解

89 (1) 心绞痛 (angina pectoris) 2 表现 3 病理基础冠状 A 粥样硬化基础上冠状 A 痉挛

90 (1) 心绞痛 (angina pectoris) 4 诱因劳累情绪激动寒冷暴饮暴食 5 疼痛机理缺血缺 O2 致酸性代谢产物堆积

91 (2) 心肌梗死 (myocardial infarction, MI) 1 定义指由于冠状 A 循环严重障, 部分心肌严重的持续性的缺血缺 O2 引起的心肌缺血性坏死

92 (2) 心肌梗死 (myocardial infarction, MI) 2 临床表现

93 (2) 心肌梗死 (myocardial infarction, MI) 3 机制 1) 严重冠状硬化 ; 2) 继发改变 : 血栓形成, 斑块内出血 3) 持续性冠脉痉挛等

94 (2) 心肌梗死 (myocardial infarction, MI) 4 发生部位

95 (2) 心肌梗死 (myocardial infarction, MI) 5 发生范围 1) 薄层梗死 ( 心内膜下梗死 ) <50% 心肌厚度 2) 厚层梗死 >50% 心肌厚度, 未达全层 3) 全层梗死若累及心内膜附壁血栓心外膜心外膜炎

96 (2) 心肌梗死 (myocardial infarction, MI) 6 病变 1) 肉眼贫血性梗死的特点

97 The tan to white areas of myocardial scarring seen from the endocardial surface here represent a remote healed myocardial infarction.

98 There has been a previous extensive transmural myocardial infarction involving the free wall of the left ventricle. Note that the thickness of the myocardial wall is normal superiorly, but inferiorly is only a thin fibrous wall. The thinned area represents a ventricular aneurysm that has developed as a consequence of the healed infarct. Such an aneurysm represents non-contractile tissue that reduces stroke volume and strains the remaining myocardium. The stasis of blood in the aneurysm predisposes to mural thrombosis.

99 The interventricular septum of the heart has been sectioned to reveal an extensive acute myocardial infarction. The dead muscle is tan-yellow with a surrounding hyperemic

100 This cross section reveals a large myocardial infarction involving the anterior left ventricular wall and septum.

101

102 (2) 心肌梗死 (myocardial infarction, MI) 6 病变 1) 肉眼 2) 光镜凝固性坏死的特点

103 坏死区心肌细胞胞浆红染颗粒状, 部分肌浆凝聚 ( ), 部分溶解, 而呈现在一条肌纤维上深浅不一的特点细胞核破碎消失

104 大片状新鲜心肌梗死除间质细胞外, 心肌细胞不见细胞核结构

105 心肌梗死发生经过一定的时间 ( 约 6 小时 ), 反应的中性粒细胞浸润于坏死细胞之间

106 大片胶原中掺杂着残存的少量心肌细胞胶原束粗大, 可见小血管和纤维细胞

107 (2) 心肌梗死 (myocardial infarction, MI) 7 合并症 Complications 心脏破裂 3%-13% 4-7 天多见室壁瘤 (Ventricular aneurysm) 10%-38% 愈合期多见附壁血栓 (Thrombosis) 急性心包炎 (Acute pericarditis) 15% 2-4 天临床并发症 (Clinical complication) 心律失常 75%-95%, 休克 10%-20%, 左心衰 60%

108 梗死区破裂口

109 A cross section through the heart reveals a ventricular aneurysm with a very thin wall at the arrow. Note how the aneurysm bulges out. The stasis in this aneurysm allows mural thrombus, which is present here, to form within the aneurysm.

110 心包内积血

111 (3) 心肌硬化 (myocardial fibrosis) 1 定义 : 指广泛心肌纤维化 2 机理 : 3 影响 :

112 (4) 冠状动脉性猝死 (sudden coronary death) 1 诱因饮酒劳累吸烟运动争吵和斗殴后 2 诊断 1) 法医 : 排除自杀与他杀 2) 病检 : 除冠状 A 和心肌病外无其它致死性疾病

113 谢谢!

114 Hypertension 高血压病

115 Definition 指以体循环动脉血压持续升高为特点的临床综合征诊断标准 : 收缩压 systolic pressure 140mmHg(18.7Kpa ) 和 ( 或 ) 舒张压 diastolic pressure 90mmHg(12.0Kpa )

116 Hypertension is clearly a major public health problem, is the most common chronic condition in both developed and developing countries.

117 Types of Hypertension Two forms of high blood pressure : Primary (or essential) hypertension 原发性高血压 Essential hypertension is a far more common condition and accounts for 90-95% of hypertension. Benign hypertension (chronic hypertension) Malignant hypertension (accelerated hypertension) Secondary (or symptomatic) hypertension 继发性高血压 Secondary hypertension, which accounts for 5-10% of hypertension Caused by a specific disorder of a particular organ or blood vessel such as: the kidney adrenal gland aortic artery.

118 Causes and Pathogenesis

119 Salt 盐 : Na + Causes and Pathogenesis Genetic factors 遗传因素 : 75% 的高血压患者有遗传素质双亲均有高血压者与无高血压家族史者比, 患病率是 2-3 倍 Obesity 肥胖 Job 职业其他 : 吸烟, 缺乏体力活动

120 Primary hypertension 原发性高血压 Benign hypertension (chronic hypertension) 良性高血压 90-95% Malignant hypertension (accelerated hypertension) 恶性高血压

121 Benign hypertension 良性高血压起病隐匿, 病程长, 进展缓慢

122 Three stages ( 一 ) 功能紊乱期 : Early stage: 全身细小动脉间歇性痉挛, 无动脉心脑肾器质性病变 Clinical features: 血压升波动性较大, 舒张压在 mmHg 之间, 伴有头痛头晕等, 可恢复正常

123 ( 二 ) 动脉病变期 : Vascular Pathology in Hypertension Large arteries 并发 atherosclerosis 动脉粥样硬化 Small blood vessel two forms: 细动脉硬化 :hyaline arteriolosclerosis 细动脉玻璃样变, 特征性病变小动脉硬化 :hyperplastic arteriolosclerosis 增生性小动脉硬化

124 ( 二 ) 动脉病变期 : 1 细动脉硬化 hyaline arteriolosclerosis hyaline degeneration 1-2 层 SMC 和直径 <1mm 的最小 A 肾入球动脉脾小体中央动脉视网膜中央动脉等

thickening of the walls of arterioles with loss of

125 1 细动脉硬化 hyaline arteriolosclerosis This vascular lesion consists of a homogeneous pink hyaline thickening of the walls of arterioles with loss of underlying structural detail and with narrowing of the lumen.

126 ( 二 ) 动脉病变期 : 2 小动脉硬化 hyperplastic arteriolosclerosis 如肾叶间动脉弓形动脉及脑小动脉病变特点 : 增生性硬化小动脉内膜胶原纤维及弹力纤维增生中膜平滑肌细胞增生肥大不同程度胶原纤维和弹力纤维增生

127 2 小动脉硬化 hyperplastic arteriolosclerosis Hyperplastic arteriolosclerosis is associated with onion- skin, 洋葱皮样 concentric, laminated thickening of the walls of arterioles with luminal narrowing.

128 ( 二 ) 动脉病变期 : Clinical features: 舒张压多在 110mmHg 以上, 波动小, 常有眩晕头痛疲乏失眠记忆减退等症状, 休息血压不能恢复正常

129 a ( 三 ) 内脏病变期病变特点 : 心脑肾等出现明显器质性病变, 舒张压可达 120mmHg 临床 : 出现器官功能障碍 The heart in hypertension : hypertensive heart disease The brain in hypertension: primary brain parenchymal hemorrhage The Kidney in hypertension

1 Morphology of Heart Hypertensive heart disease The essential feature of hypertensive heart disease is left ventricular hypertrophy (usually concentric hypertrophy : 乳头肌和肉柱增粗变圆, 但心腔不扩张, 甚至略缩小 ).

130 1 Morphology of Heart Hypertensive heart disease The essential feature of hypertensive heart disease is left ventricular hypertrophy (usually concentric hypertrophy : 乳头肌和肉柱增粗变圆, 但心腔不扩张, 甚至略缩小 ). The left ventricular wall thickness may exceed 2.0 cm and the heart weight usually exceeds 450 gm. a. Hypertrophy of the left ventricle b. Normal myocardial fibers c. Hypertrophic myocardial a fibers

131 Hypertensive heart disease 左心室向心性肥大 concentric hypertrophy 离心性肥大 eccentric hypertrophy 左心衰 ( 当心脏发生上述病变时, 即属高血压性心脏病, 高心病 )

132 2 Morphology of Brain 脑的变化 : (1) 高血压脑病 ( 急性脑水肿和颅内高压 ) hypertensive encephalopathy 由于脑血管病变及痉挛致血压骤升, 引起以中枢神经功能障碍为主要表现的征候群临床上表现为颅内高压, 头痛呕吐视力障碍及意识模糊

133 (2) 脑软化 : 由于脑的细小动脉硬化痉挛, 可致其供养区域脑组织因缺血而发生梗死, 继而坏死组织液化, 形成质地疏松的筛网状病灶脑软化通常为多数而且较小, 称微梗死灶 microinfarct, 一般不引起严重后果最终坏死组织被吸收, 由胶质瘢痕修复

134 (3) Primary Brain Parenchymal Hemorrhage 脑出血 : 最严重并发症好发部位 : 基底核和内囊最多见原因 : 1 脑内细小动脉在硬化的基础上发生持续性痉挛 ; 2 微小动脉瘤形成 ; 3 脑软化, 血管失去壁外组织支撑 ; 4 豆纹动脉从大脑中动脉直角分出

135 Massive hypertensive hemorrhage rupturing into a lateral ventricle

136 Clinical feature: 常表现为突然发生昏迷呼吸加深脉搏加速肢体驰缓肌腱反射消失大小便失禁等内囊出血者可引起对侧肢体偏瘫及感觉消失左侧脑出血常引起失语脑出血可因血肿占位及脑水肿引起颅内高压, 并可引起脑疝小的血肿可被吸收, 胶质瘢痕修复中等大的出血灶可被胶质瘢痕包裹, 形成血肿或液化呈囊腔

3 Morphology of Kidney 原发性颗粒性固缩肾 primary granular atrophy of the

atrophic, with a surface of diffuse, fine granularity that resembles

thickening of the walls of the small arteries, known as hyaline

137 3 Morphology of Kidney 原发性颗粒性固缩肾 primary granular atrophy of the kidney 细动脉硬化性固缩肾 --- 小硬轻结节状 Grossly, the kidneys are both atrophic, with a surface of diffuse, fine granularity that resembles grain leather Microscopically, the basic anatomic change is hyaline thickening of the walls of the small arteries, known as hyaline arteriolosclerosis. All structures of the kidney show ischemic atrophy, with loss of nephrons

138 Clinical features: 有轻至中度蛋白尿, 当病变严重时, 甚至出现尿毒症由于心脑病变出现较早而且严重, 因此多数病人常在此前已死于心脑并发症

139 4 视网膜的变化 : 视网膜中央动脉发生硬化眼底检查 : 可见血管迂曲, 反光增强, 动静脉交叉处出现压痕严重者视网膜渗出及出血视乳头水肿

140 Malignant Hypertension 恶性高血压

Malignant Hypertension Malignant hypertension usually presents in a younger age group (35--50 years).

坏死性细动脉炎 hyperplastic, arteriolosclerosis 增生性小动脉硬化 in the interlobular arteries 小叶间动脉 of the kidney

141 Malignant Hypertension Malignant hypertension usually presents in a younger age group ( years). clinical feature: 血压常 230/130mmHg It is characterized pathologically by necrotizing arteriolitis 坏死性细动脉炎 hyperplastic, arteriolosclerosis 增生性小动脉硬化 in the interlobular arteries 小叶间动脉 of the kidney and in the walls of a proportion of the afferent glomerular arterioles 入球小动脉. 内膜中膜纤维素样坏死内膜平滑肌 C 胶原纤维增生

142 Malignant Hypertension Similar vessel changes are seen in other organs (the heart and brain). Cerebral haemorrhage 脑出血 Although there is ischaemic damage to the kidneys in benign hypertension, death from renal failure is uncommon. Severe ischaemic damage to renal glomeruli and renal failure does, however, occur in malignant hypertension. Outcomes: 差, 如不积极治疗, 病人大多于一年内死亡, hypertensive encephalopathy 高血压脑病, renal failure

143 Summary 良恶性高血压的比较良性高血压恶性高血压 1 发病率占原发性高血压的 95% 少见 2 发病年龄多见于中老年多见于青少年 3 临床特点病程长, 进展缓慢病程短, 进展迅速 4 病理特征细小动脉玻璃样变增生性小动脉硬化坏死性细动脉炎 5 预后早期可恢复正常, 长期高血压可致心脏脑及肾的病变可出现高血压脑病, 较早出现肾衰竭, 心脏变化不明显

144 思考题名词解释 : 向心性肥大 concentric hypertrophy 问答题 : 1. 原发性高血压最基本的病变是什么? 2. 高血压脑出血最常见的部位是什么? 3. 原发性高血压最常见的死因是什么?

145 Thanks!

心血管系统疾病

心血管系统疾病张红河浙江大学医学院病理学与病理生理学系 honghezhang@zju.edu.cn 作业大体 ( 病变描写 ) 主动脉粥样硬化 (97) 高血压性心脏病 :( 代偿期 )(95)/ 失代偿期 (21) 颗粒性固缩肾 (96) 镜检切片 ( 病变图并描述病变要点 ) 冠状动脉粥样硬化 (42A) 肾小球及肾小动脉玻璃样变性 (43X) 风湿性心肌炎 (39) 实验目的和要求掌握