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发热. fever. MuDanJiang Medical College The department of pathophysiology. 2005.3. Preoptic anterior hypothalamus,POAH. 正常体温调节基本机制示意图. POAH. 调定点 (Set Point,SP). 深部温度感受器. 外周温度感受器. 骨骼肌. 外周血管. 产热. 汗腺. 散热. 平衡. (蒸发、辐射、对流、传导). 第 1 节 概述

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MuDanJiang Medical College The department of pathophysiology

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Mudanjiang medical college the department of pathophysiology

fever

MuDanJiang Medical College

The department of pathophysiology

2005.3


Mudanjiang medical college the department of pathophysiology

Preoptic anterior hypothalamus,POAH

POAH

(Set Point,SP)


Mudanjiang medical college the department of pathophysiology

1

fever0.50C

380C

38.10C~390C

39.10C~410C

>410C


Mudanjiang medical college the department of pathophysiology

  • (hyperthermia):


Mudanjiang medical college the department of pathophysiology


Mudanjiang medical college the department of pathophysiology

---

----


Mudanjiang medical college the department of pathophysiology

2

Etiology and pathogenesis

.(pyrogenic activators)EPEP

Ep

exogenous pyrogen


Mudanjiang medical college the department of pathophysiology

exogenous pyrogen

G+

1 G

---(LPS)

bacteria

lipopolysaccharide

2 VV

virus

3 ----


Mudanjiang medical college the department of pathophysiology

endotoxin, ET1600C2h

ET ETEP EP


Mudanjiang medical college the department of pathophysiology

4 ----

------

1

2 Ep

3.

4.


Mudanjiang medical college the department of pathophysiology

.

endogenous pyrogen,EP

EP


Mudanjiang medical college the department of pathophysiology

EP

  • Beesonleukocyte pyrogen , LP

  • Atkin endogenous pyrogen,EP

  • EPEPLP


Mudanjiang medical college the department of pathophysiology


Mudanjiang medical college the department of pathophysiology

1 --1 interleukin-1 IL-1

17kD

IL-1IL-1

700C 30min


2 tumor necrosis factor tnf

2. tumor necrosis factor TNF

  • TNF-TNF-

  • 700C 30min


3 interferon ifn

3. interferon IFN

  • IFNIFN


4 6 interleukin 6 il 6

4.-6 interleukin-6 IL-6

  • 18421kD

  • LPSIL-1TNF


1 macrophage inflammatory protein 1 mip 1

-1 macrophage inflammatory protein-1MIP-1

5.

(ciliary neurotrophic factor)

-8(interleukin-8, IL-8)

(endothelin)


Mudanjiang medical college the department of pathophysiology

3


Mudanjiang medical college the department of pathophysiology

LPS

LPSLBP

CD14

LPS--sCD14

EP


Mudanjiang medical college the department of pathophysiology

LPS--LBP--mCD14

LPS

Toll-like receptors , TLR

(NF-kB)


Mudanjiang medical college the department of pathophysiology

LBP

LPS

?

CD14

TLR4

?

?

NF-B pathway

MAPK pathways

TNF-IL-1IL-6etc

LPSEPEP

Cellular membrane


Mudanjiang medical college the department of pathophysiology

POAH

MAN VSA

  • EP

  • EP

  • EP


Mudanjiang medical college the department of pathophysiology

M

M

POAH

POAH

.OVLT

OVLT

EP


Mudanjiang medical college the department of pathophysiology

EP


Mudanjiang medical college the department of pathophysiology

1.

1E(prostaglandin E,PGE)

PGE

EP PGE

EP+ PGE

PGE, PGE

EP


Mudanjiang medical college the department of pathophysiology

Na+/Ca2+

0.9%NaCl

Ca2+

EGTA cAMP

CaCl2 EGTA

cAMP

EP Na+/Ca2+ cAMP

cAMP


Mudanjiang medical college the department of pathophysiology

cAMP

cAMP


Mudanjiang medical college the department of pathophysiology

AMP cAMP 5AMP

PDE--theophiline)

cAMPEP

PDE--(nicotinic acid)

cAMP

EP

.EPPGE

cAMP

cAMPEP


Mudanjiang medical college the department of pathophysiology

(4)CRH

CRH

IL-1IL-6CRH

CRHCRH CRH

CRH-R

IL-1IL-6EP

TNFIL-1CRH


Mudanjiang medical college the department of pathophysiology

5nitric oxide,NO

POAHOVLT


Mudanjiang medical college the department of pathophysiology

2.

1AVP

9 .


Mudanjiang medical college the department of pathophysiology

  • 2MSH

  • MSH

  • EPMSH

  • MSH

  • MSH

  • 31(lipocortin-1)

  • GC-1

  • -1IL-1IL-6IL-8CRH


Mudanjiang medical college the department of pathophysiology

()

EPEP

EPPOAHOVLT


Development of fever

.Development of Fever

  • (The fervescence period)

  • (The persistent febrile period)

  • (The defervescence period)


Mudanjiang medical college the department of pathophysiology

>

=

>


Mudanjiang medical college the department of pathophysiology

42 C

37C

3


3 alterations in metabolism and function

3 Alterations in Metabolism and Function

  • . (Metabolic alterations )

  • .

  • 1 .


Mudanjiang medical college the department of pathophysiology

2 .

3 .


Mudanjiang medical college the department of pathophysiology

4 .

Na+Cl-

Na+Cl-


Mudanjiang medical college the department of pathophysiology

. ( Functional alterations)

1 . Central nervous system

IL-1

------ 6~6CNS


Mudanjiang medical college the department of pathophysiology

2.Circulrtory system

HR* HR CO

+ MVO2

HR

Bp HR Bp

Bp


Mudanjiang medical college the department of pathophysiology

3 .Respiratory system

CO2

4 . Digestive system


Mudanjiang medical college the department of pathophysiology

  • .

  • 1 .

  • Fe

  • 2 .

    IL-1TNFIFN


    Mudanjiang medical college the department of pathophysiology

    3.acute phase response


    4 principles of treaments

    4 Principles of Treaments

    • Treament of primary affections

    • General treament to fever

    • 40


    Mudanjiang medical college the department of pathophysiology

    • 40

    • Antifebrile Treament

    • EP

    • AVP-MSH


    Mudanjiang medical college the department of pathophysiology

    :,,,;

    ;

    EP,;

    :(,,)

    ;

    :.


    Mudanjiang medical college the department of pathophysiology

    Case

    23

    30.5h

    PET41.4CP116/R24/BP13.3/8kPa

    ++116/

    WBC17.4109/L4~10 109/L2%16%2%80%CO2CP17.94

    mmol/L23~31mmol/L)

    1

    h38.4 C4


    Mudanjiang medical college the department of pathophysiology

    Question?

    1.

    2.

    3.

    4.


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