# 炎症（Inflammation）

- 器官 / 系统：牙齿 / 消化系统（tooth / alimentary-system）
- NTP 数据编号：ntp-0254
- 规范 URL：https://www.labsmart.cn/ntp/tooth-inflammation.html
- 中文图谱总页锚点：https://www.labsmart.cn/ntp-atlas.html#tooth-inflammation
- 原始出处：https://ntp.niehs.nih.gov/atlas/nnl/alimentary-system/tooth/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 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 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，且其中许多发生变性（化脓性渗出物，化脓性 exudate）。渗出物还可能含有细胞碎片，既来自驻留细胞群，也来自浸润的白细胞；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。取决于病变的慢性程度，渗出物周围组织中可能存在成纤维细胞（fibroblast）、纤维结缔组织和混合性炎症细胞。淋巴细胞在慢性炎症中占主导地位。淋巴细胞在慢性活动性炎症中也占主导地位，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、大型、活化巨噬细胞、上皮样巨噬细胞（epithelioid macrophage）或多核巨细胞（multinucleated giant cell）。牙齿炎症可累及牙髓（pulp）、牙骨质（cementum）、牙本质（dentin）或这些的任何组合，并可延伸至牙周组织。慢性牙齿炎症可导致牙齿吸收（tooth resorption）。牙齿炎症最常由细菌引起，但也可能是口腔内异物所致。如果细菌感染进入牙本质小管，它可扩散穿过牙本质并进入牙髓。由于牙髓被封闭在牙本质内，炎症引起的牙髓肿胀可导致髓内压升高、血流减少和缺血（ischemia）。龋齿（caries）是牙齿钙化部分炎症的肉眼术语。龋齿在小鼠或大鼠中不常见，但饮食中高水平的碳水化合物（例如蔗糖或木糖醇）可诱导其形成。牙齿炎症在伴有牙齿损伤的动物中可能是背景性发现。

## 诊断与分级建议（NTP 共识，中文）
每当存在时，牙齿炎症应当被诊断，并根据牙齿受累范围、炎症浸润的密度和受累牙齿的数量进行分级。炎症类型（例如急性、化脓性、慢性活动性）应作为修饰词纳入诊断。如果仅累及牙髓，应将术语“牙髓（pulp）”作为部位修饰词加入诊断（即“牙齿，牙髓 - 炎症”）。如果炎症累及牙本质和/或牙骨质，或者如果除牙髓外还累及牙本质和/或牙骨质，诊断应为“牙齿 - 炎症”。相关坏死不应单独诊断，除非它被认为是原发性病变（而非继发于炎症），或者其严重程度足以需要单独诊断。

## 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). The exudate may also contain cell debris, both from the resident cell populations and from infiltrating leukocytes; proteinaceous fluid containing fibrin; fewer macrophages; occasional lymphocytes or plasma cells; and, possibly, an infectious agent. Grossly, these lesions would be characterized by the presence of pus. Fibroblasts, fibrous connective tissue, and mixed inflammatory cells may be present in the tissue surrounding the exudate, 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 of the tooth can involve the pulp, the cementum, the dentin, or any combination of these and can extend to the periodontal tissues. Chronic tooth inflammation can result in tooth resorption. Tooth inflammation is most often caused by bacteria but can be the result of foreign bodies in the oral cavity. If a bacterial infection gains access to the dentin tubules, it can spread throughout the dentin and into the tooth pulp. Because of its enclosure within the dentin, swelling of the tooth pulp due to inflammation can result in increased intrapulpal pressure, decreased blood flow, and ischemia. Caries is a gross term for inflammation of the calcified portions of the tooth. Dental caries are not common in mice or rats, but high levels of carbohydrates (e.g., sucrose or xylitol) in the diet can induce their formation. Tooth inflammation can be a background finding in animals with dental injury.

## 英文原文 · Recommendation
Whenever present, inflammation of the teeth should be diagnosed and graded based on the extent of tooth involvement, the density of the inflammatory infiltrate, and the number of teeth affected. The type of inflammation (e.g., acute, suppurative, chronic active) should be included in the diagnosis as a modifier. If the tooth pulp only is involved, the term "pulp" should be added to the diagnosis as a site modifier (i.e., "tooth, pulp - inflammation"). If the inflammation involves the dentin and/or cementum, or if the dentin and/or cementum is involved in addition to the pulp, the diagnosis should be "tooth – inflammation." Associated necrosis should not be diagnosed separately unless it is considered to be a primary lesion (not secondary to the inflammation) or if it is severe enough to warrant a separate diagnosis.

## 配图
- https://www.labsmart.cn/ntp-atlas-images/ntp_0198.jpg
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