# 坏死（Necrosis）

- 器官 / 系统：骨髓 / 造血系统（bone-marrow / hematopoietic-system）
- NTP 数据编号：ntp-0428
- 规范 URL：https://www.labsmart.cn/ntp/bone-marrow-necrosis.html
- 中文图谱总页锚点：https://www.labsmart.cn/ntp-atlas.html#bone-marrow-necrosis
- 原始出处：https://ntp.niehs.nih.gov/atlas/nnl/hematopoietic-system/bone-marrow/Necrosis
- 授权：美国联邦政府作品，公有领域；引用请标注 NTP Nonneoplastic Lesion Atlas
- 适用说明：仅供科研使用，不用于临床诊断

## 一句话结论
骨髓坏死（bone marrow necrosis）的特征是细胞质空泡化、细胞边界不清、核固缩、核溶解和核碎裂（Figure 1、Figure 2）。

## 病变描述（中文）
骨髓坏死（bone marrow necrosis）的特征是细胞质空泡化、细胞边界不清、核固缩、核溶解和核碎裂（Figure 1、Figure 2）。将这些变化与死后自溶（postmortem autolysis）相区分很重要，后者可具有相似的外观。随着时间推移，受影响的造血组织被无定形颗粒状嗜酸性碎片（Figure 3、Figure 4、Figure 5）所取代，不应将其与纤维蛋白沉积相混淆。在急性期，坏死可能伴有急性炎症或出血，而后期或亚急性坏死病例可能与坏死区域内及周围巨噬细胞数量增多有关。病变分布可为局灶性（focal）、多灶性（multifocal）或弥漫性（diffuse），在缺血的情况下，可能取决于受累骨髓的血液供应。随着时间推移，坏死骨髓最终可能由造血细胞重新填充，在某些情况下，先前坏死的区域可能被纤维化所取代。骨髓坏死有若干已知原因。它可能是化合物给药（例如环磷酰胺）的直接结果，也可能继发于严重感染性疾病状态（例如败血症）或由血管损伤、血栓形成或血管闭塞引起的组织缺血。后者的具体原因包括肿瘤形成（例如肿瘤栓子、血管闭塞）、弥散性血管内凝血（血栓形成）以及暴露于内毒素（血管损伤）。由血液供应阻塞引起的坏死（梗死）在显微镜下通常具有界限清晰的边缘作为鉴别特征（Figure 3、Figure 4）。在一项评估饲料限制对常见毒理学参数影响的大鼠研究中，仅两周的严重饮食限制（减少75%）即导致骨髓坏死和变性。具体观察包括空泡化或呈坏死外观的基质细胞、造血细胞坏死、残留造血组织<25%同期对照、局灶性出血区域以及巨核细胞内易于观察到的中性粒细胞伸入运动（emperipolesis）。

## 诊断与分级建议（NTP 共识，中文）
坏死应始终记录并分级，分布应在病理学叙述中描述。关于坏死和炎症，必须区分原发性或继发性炎症过程：原发性过程应单独记录，而继发性过程仅在严重程度需要时记录或描述。大体形态学描述词，如“凝固性（coagulative）”和“干酪样（caseous）”，不应用于坏死病变的组织学描述。当观察到血栓或认为血栓是坏死的原因时，可在叙述中将其描述并解释为缺血性坏死/梗死，血栓（如存在）应单独记录。相关链接：骨髓-血管扩张 骨髓-炎症

## 英文原文 · Comment
Bone marrow necrosis is characterized by cytoplasmic vacuolization, indistinct cell borders, nuclear pyknosis, karyolysis, and karyorrhexis ( Figure 1 and Figure 2 ). It is important to distinguish these changes from postmortem autolysis, which can have a similar appearance. With time, affected hematopoietic tissue is replaced with amorphous granular eosinophilic debris ( Figure 3 , Figure 4 , and Figure 5 ) that should not be confused with fibrin deposition. In the acute stage, necrosis may be accompanied by acute inflammation or hemorrhage, while later stages or cases of subacute necrosis may be associated with increased numbers of macrophages in and around the necrotic area. Lesion distribution may be focal, multifocal, or diffuse and, in the case of ischemia, may be determined by the affected marrow blood supply. With time, necrotic marrow may eventually repopulate with hematopoietic cells, and in some cases, areas of previous necrosis may be replaced by fibrosis. There are several known causes of bone marrow necrosis. It may occur as a direct result of compound administration (e.g.,cyclophosphamide) or may be secondary to severe infectious disease states (e.g., septicemia) or tissue ischemia caused by vascular injury, thrombosis, or vascular occlusion. Specific causes of the latter include neoplasia (e.g., tumor emboli, vascular occlusion), disseminated intravascular coagulation (thrombosis), and exposure to endotoxin (vascular injury). Necrosis caused by an obstruction of the blood supply (infarct) generally has well-delineated borders microscopically as a distinguishing feature ( Figure 3 and Figure 4 ). In a rat study to evaluate the effects of feed restriction on common toxicologic parameters, severe diet restriction (75% reduction) of only two weeks resulted in bone marrow necrosis and degeneration. Specific observations included vacuolated or necrotic-appearing stromal cells, necrosis of hematopoietic cells, remaining hematopoietic tissue <25% of concurrent controls, focal areas of hemorrhage, and readily observed emperipolesis of neutrophils within the megakaryocytes.

## 英文原文 · Recommendation
Necrosis should always be recorded and graded, and the distribution should be described in the pathology narrative. Regarding necrosis and inflammation, primary or secondary inflammatory processes must be distinguished: a primary process should be recorded separately, while a secondary process need only be recorded or described if warranted by its severity. Gross morphologic descriptors, such as “coagulative” and “caseous,” should not be used for histologic description of necrotic lesions. When a thrombus is seen or is perceived to be the cause of the necrosis, it may be described and interpreted as ischemic necrosis/infarct in the narrative and the thrombus, if present, recorded separately. Related Links: Bone Marrow - Angiectasis Bone Marrow - Inflammation

## 配图
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