role of histamine, serotonin and catecholamines in portal hypertension related to Egyptian hepatic schistosomiasis

ABSTRACT

50 Egyptian inpatients with bilharzial hepatic fibrosis were selected to investigate the role of chemical mediators [histamine, serotonin and catecholamines] in the pathogenesis of portal hypertension in comparison to 10 normal control cases. They were grouped into two groups group I hepatosplenomegaly [30 cases] and group II hepatosplenomegaly with ascites [20 cases]. They were clinically examined and fully investigated [Liver functions, portal hemodynamics and blood histamine and serotonin and urinary catecholamine estimation. Partial liver dysfunction was evidenced in group II patients by jaundice, ascites and oedema of the lower limp. Liver size was reduced while their splenic size was increased than of group I. Schistosoma ova were detected in the stool of all cases, and stool ova count was higher in early and moderate cases of group I [hepatosplenomegaly without ascites]. Eoeinophelia was found as well in the same patients and there was a strong positive correlation between stool ova counts and eosinophilic counts in both groups [r + 0.516 r + 0.456 for group l and II respectively]. Also, liver functions were affected in groups II more than group I. The p values of serum bilirubin, S. G. P. T. and S. G. O. T. of patients of group II were, highly significant compared to group I [P Portal pressure [cm. saline] and portal circulation time [seconds] were higher in group I than group II and there were a positive correlation between portal pressure and portal circulation time in both groups l and II [r + 0.50 and r + 0.74 respectively]. The mean value of systemic and portal venous blood histamine and sertonin levels were found to be raised in patients with bilharzial hepatic fibrosis compared to normal controls. Urinary catecholamines also, were higher in bilharzial patients. Ascitic fluid histamine and serotonin were estimated. A measured ascitic fluid values of these mediators were markedly lower than the corresponding blood values of our patients. The mean values of portal blood histamine and portal blood serotonin were higher than systemic in both groups. There was no significant changes between the levels of these mediator in both groups. It seemed that portal venous blood level of serotonin had an important role in pathogenesis of portal hypertension as it strongly correlated with portal pressure [r+ 0.677]. Propranolol and labetalol therapies were found to reduce intrasplenic pressure in bilharzial hepatic fibrosis. The effect of labetalol was more pronounced than propranolol