염증과복구(Inflammation and Repair)

염증반응(Inflammatory Reactions)

다양한원인 – 세포손상 – 비특이적인반응

– 물리적요인 (heat or cold)– 화학적요인 (산, 알칼리..)– 미생물 (bacterium or virus)

Effects of Inflammation

• 국소적– 혈관확장 : 혈류량증가, 열, 발적– 혈관투과성증가 : 종창– 백혈구유인작은혈관의내피에부착혈관벽투과손상된조직으로이주

• 전신적- 발열, 백혈구증가

염증의특징적인징후

• Heat and redness(따뜻함과발적)– 모세혈관확장, 혈류의느려짐

• Swelling(종창)– 혈관의투과성증가-혈장유출-조직의체액증가

• Tenderness and pain(압통과통증)– 감각신경말단자극

Acute inflammation, ear Extensive burn with marked fluid extravasation

© Courtesy of Leonard Crowley, M.D./University of Minnesota Medical School

Inflammatory Process

• 급성(Acute)

다형핵백혈구(Polymorphonuclear leukocyte cell)Most important cell ; 활성화된탐식세포

단핵세포(Mononuclear cell)단핵구(monocytes), 대식세포(macrophages)나중에나타나며염증과정에서발생한잔여물제거

Inflammatory Process

• Severe inflammatory process– 전신영향이나타남 (feeling ill, fever)– 골수에서백혈구생성촉진, 혈류에순환하는백혈구수증가

– 조직손상, 상처(scar)를남기면서치유

• Mild inflammatory process– Self-limiting, 조직손상없이회복

삼출물(Exudate)• 염증반응동안생성되는단백질, 백혈구, 잔여물의혼합액체• 단백질과염증세포의비율에따라

1) 장액성 : 단백질이적은투명한액체 (화상후수포)2) 화농성 : 다수의염증세포 (농;pus)3) 섬유소성 : 혈장단백질풍부 (끈적거리는막형성)4) 출혈성 : 염증과정에서많은모세혈관파열로적혈구들이

조직으로이동하여피처럼보임

• 유착(Adhesion) 섬유소성삼출액에의해인접한 염증조직의표면막끼리붙는경우섬유조직이안으로자라들어가면서인접한표면이서로붙게될때

화학매개체(Chemical Mediator)

• 염증에의한조직손상시형성되고방출되는화학인자

1) 세포유래매개체비만세포(Mast cells):신체의결합조직에분포하는세포

세포질에 histamine(혈관확장)을분비하는과립존재

혈소판(platelet)Histamine and serotonin(혈관수축)

기타Prostaglandins Leukotrienes(세포막에있는 arachidonic acid로부터합성)

화학매개체(Chemical Mediator)

2) 혈장유래매개체일종의단백물질로비활성화합물상태로 순환하다가투과성이증가된모세혈관으로부터손상된조직으로누출된후복잡한과정을거쳐화학매개체로활성화됨

Bradykinin(혹은 kinin)보체(Complement)혈중단백질의일종

항원-항체반응에의해활성화됨

염증반응의매개물

Lysosomal Enzymes and Antigen-Antibody Reaction

• 용해소체(Lysosome)탐식성중성구와단핵구의세포질에있는과립탐식에의해세포질로들어오는물질을소화하는효소함유(세균, 외부물질등)

• Antigen-antibody reaction-조직괴사와함께염증반응동반

감염(Infection)• 미생물로인해발생하는염증

• “itis”: appendicitis, hepatitis, colitis• 봉와직염(Cellulitis) :피부, 심부조직에서급성으로염증이퍼지는감염

• 농양(Abscess) : 조직이파괴되고국소화된농덩어리형성

• 림프관염(Lymphangitis) • 림프절염(Lymphadenitis)• 패혈증(Septicemia) : 다수의세균이혈류에존재

매우강력한감염

감염(Infection)

• 병원성(Pathogenic) :capable of producing disease

• 독성(Virulence) :a measure of severity of disease

• 숙주(Host) : affected individual or animal

Infection

© Courtesy of Leonard Crowley, M.D./University of Minnesota Medical School

감염(Infection)

• Factors influencing the outcome – Virulence of organism– Numbers of invading organisms– Host resistance

만성감염(Chronic Infection)

• 병원균과숙주의방어능력이균등• 숙주의활발한치유시도로조용히진행• 숙주와병원균의균형은불안정어느쪽의힘이강해지느냐에따라진행혹은답보상태유지

• 림프구( lymphocyte) 형질세포(plasma cell)단핵구(monocyte)