腎臟原本負責調節鈉與水分的排出量,是維持體液平衡的關鍵器官。當短期內攝取的鈉量遠高於平常,腎臟需要時間才能把多餘的鈉排出,這段時間差,就是「今天吃鹹、明天腫」的生理基礎。美國家庭醫學會(AAFP)在一篇關於水腫治療的臨床回顧中指出,水腫的本質是微血管與組織間隙之間的過濾系統失衡,而鈉與水分滯留正是最常見的驅動因素之一(O’Brien et al., 2005)。
一篇2022年發表於《Frontiers in Physiology》的研究,讓受試者在32天的住院觀察中,經歷慢性睡眠限制與輪班式的作息錯位。結果發現,當睡眠時段與生理時鐘持續錯開,身體排出的總鈉量會逐漸下降,但醛固酮的分泌量並沒有跟著上升,顯示這種鈉滯留的機轉,比較可能來自腎臟對訊號的反應改變,而不是單純荷爾蒙分泌變多(McMullan et al., 2022)。
這種因為姿勢與活動量造成的水腫,在臨床上與靜脈回流不良、慢性靜脈功能不全有部分重疊,AAFP的臨床回顧也將姿勢性因素,列為評估水腫時需要考慮的常見類別之一(O’Brien et al., 2005)。多數人日常的傍晚腳腫,程度較輕、隔天起床會消退,屬於姿勢性居多,但如果腫脹持續加重或單側明顯,就需要進一步留意,這部分會在下一段說明。
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