# 肝细胞凋亡（Hepatocyte Apoptosis）

- 器官 / 系统：肝 / 肝胆系统（liver / hepatobiliary-system）
- NTP 数据编号：ntp-0409
- 规范 URL：https://www.labsmart.cn/ntp/liver-hepatocyte-apoptosis.html
- 中文图谱总页锚点：https://www.labsmart.cn/ntp-atlas.html#liver-hepatocyte-apoptosis
- 原始出处：https://ntp.niehs.nih.gov/atlas/nnl/hepatobiliary-system/liver/Hepatocyte-Apoptosis
- 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
必须认识到，肝细胞的单细胞死亡通常以凋亡（apoptosis）方式发生。肝脏中的细胞死亡表现为一系列形态学模式，这些模式可单独出现或组合出现。

## 病变描述（中文）
必须认识到，肝细胞的单细胞死亡通常以凋亡（apoptosis）方式发生。肝脏中的细胞死亡表现为一系列形态学模式，这些模式可单独出现或组合出现。然而，细胞死亡有两种主要表现形式：坏死（necrosis）和凋亡。凋亡代表一种能量依赖性细胞死亡（程序性细胞死亡）形式，通常表现为单个肝细胞的死亡。与坏死不同，凋亡是一个受调控且受基因控制的过程。单个肝细胞的凋亡可随肝细胞老化并被替换而自发发生，也可在损伤后发生，如暴露于肝毒性外源化学物或循环血液中氧张力过低。通常凋亡不伴有炎症。受累细胞与相邻正常肝细胞相比，胞质浓缩、呈深嗜酸性，并且要么无染色质，要么含有核固缩或核碎裂的物质。受累时，凋亡肝细胞可呈小、圆形，周围有透明晕。该变化在形态学上与凋亡的晚期阶段相符，这些小细胞碎片被称为凋亡小体（apoptotic bodies）（Figure 1、Figure 2，箭头）。较大、呈角状轮廓的深嗜酸性肝细胞（Figure 1、Figure 2，箭头头）代表凋亡的早期阶段，早于上述凋亡典型特征的形成。坏死通常不发生于单个细胞，尽管单细胞坏死在罕见情况下可见。坏死通常发生于成组细胞、区域性区域或带。单细胞坏死和较大面积坏死通常均伴有炎症。在某些情况下，凋亡和坏死可同时发生。

## 诊断与分级建议（NTP 共识，中文）
凋亡存在时应予以诊断，并根据凋亡细胞的数量给出严重程度分级。尽管难以与坏死区分，凋亡也可见于某些融合性凝固性坏死区域的外周边缘。在这种情况下，应诊断坏死这一主要变化。如果同一外源化学物在同一研究内于高剂量时发生坏死，而于低剂量时见凋亡，则应对每个剂量组及组内每只动物诊断最丰富的细胞死亡形式，并在病理学叙述中给出拟议的解释。

## 英文原文 · Comment
It is necessary to recognize that single-cell death of hepatocytes usually occurs by apoptosis. Cell death in the liver manifests as a spectrum of morphological patterns that can occur alone or in combinations. However, cell death has two primary manifestations: necrosis and apoptosis. Apoptosis represents a form of energy-dependent cell death (programmed cell death) that typically occurs as death of individual hepatocytes. In contrast to necrosis, apoptosis is a regulated and genetically controlled process. Apoptosis of individual hepatocytes may occur spontaneously as hepatocytes age and are replaced, or following injury such as exposure to hepatotoxic xenobiotics or low oxygen tension in the circulating blood. Usually no inflammation is associated with apoptosis. Affected cells have condensed, deeply eosinophilic cytoplasm in contrast to adjacent normal hepatocytes and either are devoid of chromatin or contain pyknotic or fragmented nuclear material. When affected, apoptotic hepatocytes may be small, rounded, and surrounded by a clear halo. This change is morphologically compatible with an advance stage of apoptosis, and the small cell fragments are referred to as apoptotic bodies ( Figure 1 and Figure 2 , arrows). Larger, angular profiles of hypereosinophilic hepatocytes ( Figure 1 and Figure 2 , arrowheads) represent early stages of apoptosis prior to development of the classical features of apoptosis described above. Necrosis does not typically occur in individual cells, though single-cell necrosis is seen in rare instances. Necrosis usually occurs in groups of cells, regional areas, or zones. Both single-cell necrosis and larger areas of necrosis are typically accompanied by inflammation. In some cases, apoptosis and necrosis can occur together.

## 英文原文 · Recommendation
Apoptosis should be diagnosed when present and given a severity grade based on the number of apoptotic cells. Although difficult to distinguish from necrosis, apoptosis can also be found at the peripheral edges of some regions of confluent coagulation necrosis. In this situation the predominant change of necrosis should be diagnosed. If necrosis occurs at high doses of a xenobiotic but apoptosis is seen at low doses with the same xenobiotic and within the same study, then the most abundant form of cell death should be diagnosed for each dose group and animal within a group and a proposed interpretation given in the pathology narrative.

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