重症监护患者和对照组皮内钠储存的观察研究-荷兰吕伐登医疗中心，格罗宁根大学医学中心内科-肾病学系

The development of ICU-acquired sodium disturbances is not fully understood. Alterations in non-osmotic skin sodium storage, hypothetically inflammation-driven, could play a role. To investigate this in critically ill patients we conducted a patient-control study with skin punch biopsies in patients with sepsis (n = 15), after coronary artery bypass grafting (CABG, n = 15) and undergoing total hip arthroplasty (THA-controls, n = 15) respectively, together representing a range in severity of systemic inflammation. Biopsies were taken within 24 hours (sepsis) and within 2 hours (CABG) after ICU-admission, and prior to arthroplasty. Biopsies were analysed for sodium content. In addition immunostainings and quantitative real time PCR were performed. The primary aim of this study was to detect possible differences in amounts of cutaneous sodium. The secondary aims were to quantify inflammation and lymphangiogenesis with concomitant markers. The highest amounts of both water and sodium were found in patients with sepsis, with slightly lower values after CABG and the lowest amounts in THA-controls. Correlation between water and sodium was 0.5 (p<0.01). In skin biopsies in all groups comparable amounts of macrophages, T-cells and lymph vessels were found. In all groups comparable expression of inflammation markers were found. However, higher mRNA transcript expression levels of markers of lymphangiogenesis were found in patients with sepsis and after CABG. The conjoint accumulation of water and sodium points towards oedema formation. However, the correlation coefficient of 0.5 leaves room for alternative explanations, including non-osmotic sodium storage. No signs of dermal inflammation were found, but upregulation of markers of lymphangiogenesis could indicate future lymphangiogenesis.

ICU获得的钠紊乱的发展尚未完全了解。非渗透皮肤钠储存的变化，假设是炎症驱动的，可能起作用。为了在危重患者中研究这一点，我们分别对脓毒症患者（n=15），冠状动脉旁路移植（CABG，n=15）和进行全髋关节成形术（THA对照，n=15）进行了皮肤穿刺活检的患者对照研究，共同代表全身炎症严重程度的范围。在ICU入院后24小时内（败血症）和2小时内(CABG)以及关节成形术前进行活检。活检分析钠含量。此外，进行免疫染色和定量实时PCR。本研究的主要目的是检测皮肤钠量的可能差异。次要目的是用伴随标志物量化炎症和淋巴管生成。在脓毒症患者中发现水和钠的最高量，CABG后值略低，THA对照中的最低量。水与钠的相关性为0.5（p<0.01）。在滑雪