Study Of Enzymatic Activity In Chronic Liver Disease In Egyptian Children:

Bahaa Eldin Mohamed Hassanein

-2n-S tlIoII4ARY------Chronic liver disease in Egyptian children isone of the leading oauses of morbidity and mortalityin Egypt.This study was carried out on 45 children agedbetween 2 years and 14 years including 30 males, 15females and 15 nomal control children of the sameagegroup (11 males and 4 females).Theywere selected fram patients~ admitted toEl-Mounira children Hospital Cairo University in theyear 1982 end 1983.The main presenting features was hepatomegalyof somemonths duration. Their history, physicalecamination and investigations were carried out wepay muchattention to the Enzymaticaotivity in theserum and its Correlation with both clinical andhistopathological studies of the patients.Aocordingto histopathological findings thecases were classified into the following 5 subgroups•.. _. __.._--~------~-272-Chronio aotive hepatitis 9 oases (2~)Post-hepatitio oirrhosis 11 oases(24.4%)Veno-ooo~uaivedisease 6 oases(~J.J%)14. Pure-bilharzial hepatiofibrosis12 oases(26.7%)15. Mixed (Shistosamiasis andother lesions)7 oases(15.6%)Each group was studied separately for its olinicalIpioture and its oorreletion to both histopathological &:Ibiochemical investigations with laying an stress onIthe statisti~ analysis of biochemical resuJ.tSIII. Chronic active group (20%). -------------------------The biochemi~ p:r;’ofile suggesting the diagnosisI:lfC.A.H. according to our findings were Ii- Serum transaminasss SGOTand SGPTincreased by4.5 - e folds the normal.!- Total serum protein was elevated.!- MarkedhypergammaglobuJ.inaemiaby J folds ofnormal mean.Serum bilirubin was increased by 2 folds ofnormal range with the mean of l.J;t0.8 DIg %.-273-- Alkaline phosphatase was increased only by l2fold of normal level.- Serum L.D.H. was increased by about 3 folds otnormal level.- Serum GGT was found about 2.75 folds of normallevel.II. Post-hepatitic cirrhosis (22.4%) --------------------------------The biochemical profile suggesting the diagnosisof P.H.C. according to our tindings were:- Mean serum albumin was 50% lower than the normalmean level. - ””’-2 globulin ot protein eJectrophoresis wasincreased above normal range.B globulin levels were found either slightlyincreased or within the normal range.- Gammaglobulin level in protein electrophoresiswes elevated by more than 2 folds of the normallevel.- Serum bilirubin was increased by about 2.75 foldsot normal level.-274-- Serumalalille phospatase was either withill thenormal level or very slightly inoreased.- Serum transaminases were found to be illcreased by2 folds of normal.- Serum GGTiwas increased by about 3 folds ofnormal level.III. Veno-ooclusive disease(13.)%)The biochemical profile suggestillg the diagnosiso:e V.O.D. according to our findings were I- MeanSGPTlevel was almost no:rmal.- MeanSGOTlevel was mildly elevated.Meantotal serum protein levels were decreasedby 25% below the normal level.- Meanserum albumill was below normal by about25% ofnnormal level.- Mean.,,’ globulin was markedly d1millished byabout 90%of the normal level.- Serum gammaglobulill was normal.Serum bilirubill was moderatly illcreased by 2folds of normal level.- 75-- Serum L.D.H. was very sligJatly increased orabout nonnal.- Serum GGTwas high by about J folds of normallevel.lY. Pure hepatic schistos iasis (26.7%)--------------------- -------------The biochemical profi e suggesting the diagnosis0:[ pure hepatic schistosomi ses aocording to our find:Lngswerel- Total serum proteindecreased.d serum albumin wereSerum c<. 1 • 00<. 2 and B globulin were at normalleve],.-Serum gamma globulinof the normal level.s increased by 2 foldsSerum transeminases w re elevated by about ~folds of normal in SGT and 5.5 folds of normallevel in SGOT.- Slight elevation of a1.75 folds of normal.line phosphatase by- SerumGGTactivity wa elevated to more thanJ folds of normal lev 1.-216-IV. Hepatio bilharzial fibrosis with other lesions----------------------------------------------(mixed type) (15.6%)----------------------The bioohemical profile suggesting the diagnosiscf hepatio bilharzial fibrosis with other hepatitislesion aooording to our findings werea•. Marked elevation of both SGPT(meanlevel morethan 1folds of normal level) and SOOT(meanlevel was more than 12 folds of normal level).•. Total serum protein levels were near normallevel.•. B-globulin mean level was J~ below normal level.•• Serumgammaglobulinwas increased by 2.5 foldsof normal level.•• Serumalkaline phosphatase was inoreased by 1.15folds of normal••, SertunLDII& SerumGGTwere inoreased above normalby 2.5 and 3.5 folds of normal in Sequenoe.Out of these study we can ooncluded that it ispossible to gain a great value from biochemical teststo confirm the diagnosis of chronio hepatio insult beside-277-the findings of histopatho~ogica~ biopsies.It is very important to knowthe exaot level ofserum enzymesof dUferent diseases re~at1ve to thenorma~~eve~. It is either above normaJ.level t nODialor subnorma~by adefinite numberof fo~ds•