# 角化过度（Hyperkeratosis）

- 器官 / 系统：食管 / 消化系统（esophagus / alimentary-system）
- NTP 数据编号：ntp-0311
- 规范 URL：https://www.labsmart.cn/ntp/esophagus-hyperkeratosis.html
- 中文图谱总页锚点：https://www.labsmart.cn/ntp-atlas.html#esophagus-hyperkeratosis
- 原始出处：https://ntp.niehs.nih.gov/atlas/nnl/alimentary-system/esophagus/Hyperkeratosis
- 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
角化过度（hyperkeratosis）是食管常见的改变。角化过度（角质层增厚）有两种形式：正角化性角化过度（orthokeratotic hyperkeratosis）或角化不全性角化过度（parakeratotic hyperkeratosis）。

## 病变描述（中文）
角化过度（hyperkeratosis）是食管常见的改变。角化过度（角质层增厚）有两种形式：正角化性角化过度（orthokeratotic hyperkeratosis）或角化不全性角化过度（parakeratotic hyperkeratosis）。在正角化性角化过度（有时称为正角化，orthokeratosis）中，鳞状上皮细胞无核，而在角化不全性角化过度（有时称为角化不全，parakeratosis）中，鳞状上皮细胞保留固缩的细胞核。角化过度常伴随增生。饮食成分影响角化，低纤维、低蛋白或液体饮食会导致角化上皮层厚度增加。此外，不进食的动物常出现食管角化过度而无相关增生。无增生的角化过度与作为上皮增殖增强过程一部分而发生的角化过度，在解释意义上有所不同。在厌食的啮齿类动物中，过多的角质推测是由于食物通过所致的机械性去除减少。在食管角化过度与厌食相关的情况下，前胃通常也出现角化过度。在这些情况下，将没有基底细胞层增殖反应增强的证据。另外，维生素失衡和锌缺乏可引起角化不全性角化过度及相关鳞状细胞增生。

## 诊断与分级建议（NTP 共识，中文）
当黏膜增生存在时，角化过度常可见到，通常不作为一个独立病变诊断，尽管可在叙述中增生的描述中提及。当角化过度存在而无增生，或角化过度极严重时，则应记录并分级。严重程度分级基于角质厚度程度和食管受累面积。诊断中角化过度不分为正角化和角化不全，但应在叙述中充分描述。

## 英文原文 · Comment
Hyperkeratosis is a common alteration of the esophagus. Hyperkeratosis (thickening of the stratum corneum) occurs in two forms: orthokeratotic or parakeratotic hyperkeratosis. In orthokeratotic hyperkeratosis (sometimes referred to as orthokeratosis squamous epithelial cells are anuclear, whereas in parakeratotic hyperkeratosis (sometimes referred to as parakeratosis) the squamous epithelial cells have retained pyknotic nuclei. Hyperkeratosis frequently accompanies hyperplasia. Dietary composition affects keratinization, with low-fiber, low-protein, or liquid diets resulting in increased thickness of the keratinized epithelial layer. Also, animals that are not eating will often have hyperkeratosis of the esophagus without associated hyperplasia. Hyperkeratosis in the absence of hyperplasia has interpretative implications different from those of hyperkeratosis occurring as part of the process of enhanced epithelial proliferation. In the anorectic rodent, the excess keratin is presumably the result of reduced mechanical removal by the passage of food. In cases of hyperkeratosis in the esophagus associated with anorexia, hyperkeratosis is usually also present in the forestomach. In these situations, there will be no evidence of an increased proliferative response in the basal layer. Alternatively, vitamin imbalance and zinc deficiency can cause parakeratotic hyperkeratosis and associated squamous cell hyperplasia.

## 英文原文 · Recommendation
Hyperkeratosis is often seen when hyperplasia of the mucosa is present and is usually not diagnosed as a separate entity, although it may be mentioned in the description of hyperplasia in the narrative. When hyperkeratosis is present in the absence of hyperplasia or when hyperkeratosis is extreme, then it should be documented and graded. The severity grade is based on the degree of thickness of the keratin and the area of the esophagus affected. Hyperkeratosis is not divided into orthokeratosis and parakeratosis in the diagnosis, but this should be well described in the narrative.

## 配图
- https://www.labsmart.cn/ntp-atlas-images/ntp_0009.jpg
- https://www.labsmart.cn/ntp-atlas-images/ntp_0013.jpg

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