Study on the pulmonary microvascular thromboembolism associated with severe influenza virus infection in the elderly

长期以来，流感一直是一种具有全球重要性的重大和高度传染性疾病。我们招募了2001年1月至2003年3月在我院医院流感季节出现高热（38.5℃以上）、全身乏力、低氧血症的老年患者18例，平均年龄78.6岁，年龄范围69 ~ 91岁。在这些科目中。流感诊断试剂盒诊断为甲型流感（H3N2）病毒感染11例（男7例）。在11例流感患者中，5例血清d -二聚体(平均。482 ng/ml vs 215 ng/ml)和呼出的CO浓度(平均。7.2 PPM vs 1.6 PPM)显著高于其余6例患者。5例患者中有4例肺灌注扫描显示双肺多发结节性缺损（图）。经诊断为肺微血管血栓栓塞，同意接受肝素和尿激酶治疗的3例患者最终存活。然而，1例不同意抗凝治疗的患者死于急性严重呼吸衰竭。这些结果表明，肺微血栓栓塞是甲型流感病毒感染的一个重要并发症，及时诊断对于挽救患者免于流感相关的急性死亡至关重要。

Influenza has been a significant and highly contagious disease of global importance for a long time. We recruited 18 elderly patients (mean age, 78.6, range 69-91 years) with high grade fever (more than 38.5℃) general fatigue and hypoxemia during flu seasons from January 2001 to March 2003 in our university hospital. Among those subjects. 11 patients (7 male) were dignosed as having influenza A (H3N2) virus infection by influenza diagnosing kit. In 5 out of 11 influenza patients, serum D-dimer (mean. 482 ng/ml vs 215 ng/ml) and exaled CO concentrations (mean. 7.2 ppm vs 1.6 ppm) were significantly higher compared with the remained 6 patients, respectively. In 4 out of 5 patients, pulmonary perfusion scan revealed multiple nodular defects in the bilateral lungs (figure). Pulmonary microvascular thromboembolism was diagnosed and three patients who agreed to receive heparin and urokinase therapy survived finally. However, one patient who disagreed to anti-coagulant therapy died with acute severe respiratory fai lure. These results suggest that pulmonary microthromboemboli is an important complication of influenza A virus infection and prompt diagnosis is essential to save the patients from acute death associated with influenza.