# 炎症（Inflammation）

- 器官 / 系统：鼻 / 呼吸系统（nose / respiratory-system）
- NTP 数据编号：ntp-0142
- 规范 URL：https://www.labsmart.cn/ntp/nose-inflammation.html
- 中文图谱总页锚点：https://www.labsmart.cn/ntp-atlas.html#nose-inflammation
- 原始出处：https://ntp.niehs.nih.gov/atlas/nnl/respiratory-system/nose/Inflammation
- 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
在NTP研究中，炎症有五个标准类别：急性（急性（acute））、化脓性（化脓性（suppurative））、慢性（慢性（chronic））、慢性活动性（慢性活动性（chronic-active））和肉芽肿性（肉芽肿性（granulomatous））。

## 病变描述（中文）
在NTP研究中，炎症有五个标准类别：急性（急性（acute））、化脓性（化脓性（suppurative））、慢性（慢性（chronic））、慢性活动性（慢性活动性（chronic-active））和肉芽肿性（肉芽肿性（granulomatous））。在急性炎症中，主要浸润细胞是中性粒细胞（neutrophil），尽管也可能存在较少的巨噬细胞（macrophage）和淋巴细胞（lymphocyte）。还可能有水肿或充血（hyperemia）的证据。中性粒细胞也是化脓性炎症中的主要浸润细胞类型，但中性粒细胞聚集，其中许多发生退变（化脓性渗出物，化脓性 exudate）。渗出物中还可能存在来自 resident 细胞群和浸润白细胞的细胞碎片；含纤维蛋白（fibrin）的蛋白性液体、较少的巨噬细胞、偶见的淋巴细胞或浆细胞（plasma cell）；以及可能的感染因子。肉眼上，这些病变以脓液存在为特征。渗出物周围组织可能含有成纤维细胞（fibroblast）、纤维结缔组织（fibrous connective tissue）和混合性炎症细胞，取决于病变的慢性程度。淋巴细胞在慢性炎症中占主导。淋巴细胞在慢性活动性炎症中也占主导，但也存在显著数量的中性粒细胞。两种病变均可能含有巨噬细胞。肉芽肿性炎症是慢性炎症的另一种形式，但该诊断要求存在显著数量的聚集性、大的、活化的巨噬细胞、上皮样巨噬细胞（epithelioid macrophage）或多核巨细胞（multinucleated giant cell）。炎症与细胞浸润的鉴别在于存在其他改变，如水肿、出血、变性、坏死或其他组织损伤证据。鼻部炎症常与其他病变同时出现，如邻近上皮的坏死、增生、化生或萎缩。也可能见到其他可能为病因的相关病变，如异物（foreign body）（Figure 1）或鼻甲（turbinate）骨坏死（Figure 3）。当观察到的鼻部病变符合提示性模式时（例如Figure 4、Figure 5、Figure 6、Figure 7所示），需要考虑反流诱导的鼻部病变。反流相关病变倾向于在鼻腔腹侧和外侧更为严重，在鼻背内侧切面较不明显，在后部鼻切面更为严重，严重程度在前部鼻切面逐渐减弱。反流诱导的鼻部病变可能以单侧为主。

## 诊断与分级建议（NTP 共识，中文）
当鼻部炎症是原发性病变时，应当诊断并分级。如果在整个研究过程中炎症被认为是另一过程（例如坏死）的继发性改变，则不应单独诊断炎症，而应在叙述中将其描述为原发性病变的组成部分，除非炎症严重到足以需要单独诊断，或与原发性病变相比严重程度不成比例。炎症的诊断应包括炎症类型（急性、慢性等）作为修饰词，以及鼻腔内病变位置作为部位修饰词（例如呼吸上皮、嗅上皮、鼻咽管、犁鼻器）。如果多个部位受累，诊断应按受累上皮类型（即鳞状、移行、呼吸或嗅上皮）分开，但同时受累部位（如鼻泪管或犁鼻器）的炎症可在病理学叙述中描述。病理学叙述应描述炎症的特征、鼻腔内浆液性、纤维蛋白性或黏液性液体的存在，并注明相关病变。骨和软骨改变以及粘连（synechia）（如果存在）应单独诊断。如果有感染因子（如真菌）或与病变相关的异物，也应单独诊断（细菌除外，细菌不应单独诊断，而应在叙述中描述）。相关链接：鼻 - 嗅上皮 - 萎缩

## 英文原文 · Comment
In NTP studies, there are five standard categories of inflammation: acute, suppurative, chronic, chronic-active, and granulomatous. In acute inflammation , the predominant infiltrating cell is the neutrophil, though fewer macrophages and lymphocytes may also be present. There may also be evidence of edema or hyperemia. The neutrophil is also the predominant infiltrating cell type in suppurative inflammation , but the neutrophils are aggregated, and many of them are degenerate (suppurative exudate). Cell debris, from both the resident cell populations and infiltrating leukocytes; proteinaceous fluid containing fibrin, fewer macrophages, occasional lymphocytes or plasma cells; and, possibly, an infectious agent may also be present in within the exudate. Grossly, these lesions would be characterized by the presence of pus. The tissue surrounding the exudate may contain fibroblasts, fibrous connective tissue, and mixed inflammatory cells, depending on the chronicity of the lesion. Lymphocytes predominate in chronic inflammation . Lymphocytes also predominate in chronic-active inflammation , but there are also a significant number of neutrophils. Both lesions may contain macrophages. Granulomatous inflammation is another form of chronic inflammation, but this diagnosis requires the presence of a significant number of aggregated, large, activated macrophages, epithelioid macrophages, or multinucleated giant cells. Inflammation is differentiated from cellular infiltrates by the presence of other changes, such as edema, hemorrhage, degeneration, necrosis, or other evidence of tissue damage. Nasal inflammation is frequently seen in conjunction with other lesions, such as necrosis, hyperplasia, metaplasia, or atrophy of the adjacent epithelium. Other associated lesions that may be causative, such as a foreign body ( Figure 1 ) or bone necrosis in the turbinates ( Figure 3 ) may also be seen. Reflux-induced nasal lesions need to be considered when the observed nasal lesions fit a suggestive pattern (e.g., as shown in Figure 4 , Figure 5 , Figure 6 , and Figure 7 ). Reflux-related lesions tend to be more severe ventrally and laterally in the nasal cavity, less pronounced in the dorsal medial sections of the nose, and more severe in the posterior nasal sections, with severity tapered off in the anterior nasal sections. Reflux-induced nasal lesions may have a unilateral predominance.

## 英文原文 · Recommendation
Inflammation of the nose should be diagnosed and graded when it is a primary lesion. If the inflammation is considered to be secondary to another process (e.g., necrosis) throughout the study, then the inflammation should not be diagnosed separately but should be described in the narrative as a component of the primary lesion, unless the inflammation is severe enough to warrant a separate diagnosis or is disproportionately severe compared to the primary lesion. The diagnosis of inflammation should include the type of inflammation (acute, chronic, etc.) as a modifier, and the location of the lesion within the nasal cavity as a site modifier (e.g., respiratory epithelium, olfactory epithelium, nasopharyngeal duct, vomeronasal organ). If multiple sites are affected, the diagnoses should be separated by type of epithelium affected (i.e., squamous, transitional, respiratory, or olfactory), but inflammation of concurrently affected sites, such as the nasolacrimal ducts or the vomeronasal organ, may be described in the pathology narrative. The pathology narrative should describe the features of the inflammation, presence of serous, fibrinous, or mucous fluid within the nasal cavity, and note associated lesions. Osseous and cartilaginous changes, as well as synechia, if present, should be diagnosed separately. If there is an infectious agent, such as fungus, or a foreign body associated with the lesion, it should also be diagnosed separately (except for bacteria, which should not be diagnosed separately but should be described in the narrative). Related Links: Nose - Olfactory Epithelium - Atrophy

## 配图
- https://www.labsmart.cn/ntp-atlas-images/ntp_0923.jpg
- https://www.labsmart.cn/ntp-atlas-images/ntp_0924.jpg

整理：北京天融慧通科技有限责任公司（LabSmart）｜ https://www.labsmart.cn