# 坏死（Necrosis）

- 器官 / 系统：骨骼肌 / 骨骼肌肉系统（skeletal-muscle / musculoskeletal-system）
- NTP 数据编号：ntp-0588
- 规范 URL：https://www.labsmart.cn/ntp/skeletal-muscle-necrosis.html
- 中文图谱总页锚点：https://www.labsmart.cn/ntp-atlas.html#skeletal-muscle-necrosis
- 原始出处：https://ntp.niehs.nih.gov/atlas/nnl/musculoskeletal-system/skeletal-muscle/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
多种类型的损伤，包括创伤、缺血、感染因子和肌毒素，均可引起肌纤维坏死。肌纤维坏死（myonecrosis）的组织学特征为肿胀、深嗜酸性、均质化的肌纤维，横纹消失（透明化）。

## 病变描述（中文）
多种类型的损伤，包括创伤、缺血、感染因子和肌毒素，均可引起肌纤维坏死。肌纤维坏死（myonecrosis）的组织学特征为肿胀、深嗜酸性、均质化的肌纤维，横纹消失（透明化）。受累纤维常呈空泡化并碎裂，伴核固缩（Figure 1）。常并发炎症。营养不良性矿化（Figure 2、Figure 3）也可发生。肌纤维变性和再生的不同阶段也常同时存在（见 Skeletal Muscle - Degeneration 和 Skeletal Muscle - Regeneration）。变性和坏死代表病变的一个连续过程，因此二者常同时存在于同一病变中。由于骨骼肌反应方式有限，二者具有相似的形态学特征，因而在组织学上难以区分。这会给诊断带来挑战。在评价毒性研究时，病理学家必须为这两种病变建立明确的判定标准，并在应用时保持一致和审慎。标准应在描述中予以说明。“肌病（myopathy）”一词通常用于描述以变性和坏死为主要特征的骨骼肌疾病。然而，由于肌病是一个笼统的术语，且通常涵盖一组病变而非某一独立病变，故不推荐使用该词。

## 诊断与分级建议（NTP 共识，中文）
当坏死被视为主要病变时，例如梗死，应作出诊断并赋予严重程度分级。如果一项研究中同时存在变性和坏死，应诊断占优势的病变，并在病理学描述中描述另一病变。然而，如果同时记录两种病变最能描述所发生的变化，病理学家可同时记录两种病变。伴随的再生通常不应单独记录，除非其程度显著，但应在描述中予以说明。其他继发性病变，如炎症和出血，除非严重程度足以支持，否则不应单独诊断，但应在描述中予以说明。相关链接：Skeletal Muscle - Degeneration Skeletal Muscle - Regeneration

## 英文原文 · Comment
Numerous types of injury, including trauma, ischemia, infectious agents, and myotoxins, can cause myofiber necrosis. Myofiber necrosis (myonecrosis) is histologically characterized by swollen, deeply eosinophilic, homogeneous myofibers that lack cross striations (hyalinization). Affected fibers are often vacuolated and fragmented with pyknotic nuclei ( Figure 1 ). Concurrent inflammation is common. Dystrophic mineralization ( Figure 2 and Figure 3 ) can also occur. Various stages of myofiber degeneration and regeneration are also often present (see Skeletal Muscle - Degeneration and Skeletal Muscle - Regeneration ). Degeneration and necrosis represent a continuum of lesions and therefore are often both present within a given lesion. Due to the limited repertoire of skeletal muscle responses, they share similar morphologic features and can thus be difficult to differentiate histologically. This can create a diagnostic challenge. When evaluating a toxicity study, it is important for the pathologist to establish distinct criteria for both lesions and to be consistent and careful when applying them. Criteria should be described in the narrative. The term "myopathy" has commonly been used to describe disorders of skeletal muscle in which degeneration and necrosis are key features. However, since myopathy is a general term and one that typically encompasses a collection of lesions rather than one distinct lesion, its use is not recommended.

## 英文原文 · Recommendation
When necrosis is considered the primary lesion, such as with infarction, the lesion should be diagnosed and assigned a severity grade. If both degeneration and necrosis are present in a study, the predominant lesion should be diagnosed and the other described in the pathology narrative. However, the pathologist may record both lesions if it best describes the changes that are occurring. Concomitant regeneration should generally not be recorded separately unless present to a significant extent but should be described in the narrative. Other secondary lesions, such as inflammation and hemorrhage, should not be diagnosed separately unless warranted by severity but should be described in the narrative. Related Links: Skeletal Muscle - Degeneration Skeletal Muscle - Regeneration

## 配图
- https://www.labsmart.cn/ntp-atlas-images/ntp_0553.jpg
- https://www.labsmart.cn/ntp-atlas-images/ntp_0547.jpg

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