Résumé
Shistosomal cor-pulmonale [SCP] is one of the most important causes of vascular cor-pulmonale in Egypt. The aim of the work was to study the role of endothelial coagulation interaction in the initiation and /or progression of SCP. The study was carried out on 26 male schistosomal patients. They were divided into 2 groups: Group I [GI]: 16 patients with SCP. Group II [GII]: 10 schistosomal non-corpulmonale patients of matched age. All patients were subjected to cardiac Echo-Doppler study and right heart catheterization for measurement of blood pressure in the pulmonary artery and right ventricle. Blood samples obtained from the pulmonary artery were utilized for measurement of: - Fibrinogen. - vWF activity.-Platelet aggregation index.- Fibrin monomers. vWF activity was significantly higher in GI[173.4 +/- 58%] compared with GII [109.8 +/- 17.3%] and there was a statistically significant positive correlation between vWF activity and systolic pulmonary artery pressure [SPAP] [r = 0.654],P = 0.006] and a statistically significant negative correlation between vWF activity and platelet aggregation index [r = -0.6557,P 0.006]. Fibrinogen level was found to be significantly lower in GI [149 +/- 25.2 mg%] compared with GII [269 +/- 36.3 mg%]. Several signs indicating intra-vascular coagulopathy have been observed in GI since platelet aggregation index in that group [0.69 +/- 0.09] was markedly lower than its value in GII [0.95 +/- 0.02], signifying the increased propensity for thrombosis inside the pulmonary artery in GI compared with GII. Moreover, fibrin monomers have been detected in the pulmonary artery in 87% of cases of GI while they were not detected in any case in GII. We conclude that endothelial dysfunction and local coagulopathy in lung vasculature of SCP patients are important to proggression, if not initiation, of pulmonary hypertension