MINISTRY OF EDUCATION AND TRAINING MINISTRY OF DEFENCE
108 INSTITUTE OF CLINICAL MEDICAL AND PHARMACEUTICAL SCIENCES
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NGUYEN THI THANH THUY
RESEARCH OF HEPATITIS C VIRUS
GENOTYPES IN HEPATOCELLULAR
CARCINOMA PATIENTS
Speciality: Gastroenterology
Code: 62.72.01.43
SUMMARY THESIS’ DOCTOR OF MEDICINE
HANOI – 2018
THE THESIS WAS DONE IN: 108 INSTITUTE OF CLINICAL
MEDICAL AND PHARMACEUTICAL SCIENCES
Supervisor:
1. Prof. PhD. Mai Hong Bang
2. Ass. Prof. PhD. Cao Minh Nga
Reviewer:
1.
2.
3.
This thesis will be presented at Institute Council at: 108 Institute of
Clinical Medical and Pharmaceutical Sciences
Day Month Year
The thesis can be found at:
1. National Library of Vietnam
2. Library of 108 Institute of Clinical Medical and
Pharmaceutical Sciences
3. Central Institute for Medical Science Infomation and
Tecnology
1
1. Introduction
Hepato cellular carcinoma (HCC) is a popular cancer
ranking the sixth in the world, in which ranking fifth in male and
eighth in female with many changes over time. This is the third
reason causing cancer-death in Asia-Pacific region.
Beside hepatitis B, hepatitis C is an important causal factor
related to hepato cellular carcinoma (HCC). Hepatitis C virus (HCV)
causes hepato cellular carcinoma (HCC) by promoting the
inflammation and fibrosis process on liver, eventually causing
cirrhosis and hepato cellular carcinoma (HCC). Although there are
lots of debates about the mechanism causing HCC of HCV, recent
researches had mentioned the role of HCV genotype. In Vietnam,
there have been researches on HCV genotypes in patients with acute
or chronic hepatitis C, but not having adequate researches about
HCV genotypes in HCC patients on foundation of hepatitis C virus.
From the above-mentioned reasons, we conduct this research aiming
to:
1.1. Describing clinical and characteristics laboratory features and
identifying HCV genotype on patients of HCC.
1.2. Evaluating relationship between HCV genotypes and some
clinical characteristics laboratory features,on patients of HCC.
2. Necessity
Six (06) HCV genotypes have been identified currently. In
Vietnam, researches on chronic hepatitis C patients are most
commonly found in genetype 6, followed by genotype 1 then
genotype 2. Some authors referred to the high risk of causing hepato
cellular carcinoma on patients that infect HCV with genotype 1 (1b);
but other researches referred to the high risk on patients that infect
HCV with genotype 3. Therefore, researching the role of HCV
genotypes on patients of hepato cellular carcinoma is essential work,
contributing to clarify disease’s mechanism.
3. New contributions of thesis
Thesis identified genotype and subtype of hepatitis C virus
on 68 patients with HCC and 63 patients with HCV chronic hepatitis.
Thesis concurrently showed the risk of hepato cellular carcinoma in
patients with HCV genotype 1b were 4.92 times higher than patients
of HCV non-1b (p = 0.008; OR = 4.92; 95% CI: 1.52 – 15.96).
2
Research had also identified linear relationship between genotype 1b
and HCV load in patients with hepato cellular carcinoma (HCC)
4. Thesis outline:
Thesis was presented in 128 pages including introduction 2
pages, overview 38 pages, object and method of research 20 pages,
research results 32 pages, discussion 33 pages, conclusion 2 pages
and petition 1 pages.
Thesis includes 44 tables, 14 graphs, and 146 reference
documents in which 29 Vietnamese documents and 117 English
documents.
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CHAPTER 1
OVERVIEW
1.1. Epidemiology of hepato cellular carcinoma (HCC):
Hepato cellular carcinoma is a popular cancer ranking sixth in
the world. In Vietnam, author Vuong Anh Duong (2010) certified
liver cancer ranking the third among other cancer diseases in male.
According to statistic of author Nguyen Dinh Song Huy (2015) from
2010 to 2014, patients with HCC increased year by year mostly in
male patients. The main reason was hepatitis B virus and hepatitis C
virus.
1.2. Biological characteristics of hepatitis C virus
1.2.1. Characteristics of form and structure: Hepatitis C virus
(HCV) is a virus in the Flaviviridae family with structure of RNA
single sequence.
1.2.2. Genotype characteristics
During replication period, HCV must use RNA poly merase
enzyme, which is not capable of correcting in RNA synthetic process
that diversifies HCV gene set, so it is classified HCV in different
types.
Genotype identification and classification are based on
nucleotide order. If discrepant order of nucleotide > 20% we have
different genotypes. If discrepant order of nucleotide ≤ 20% we have
different subgroup of same genotype.
It is identified currently six (06) HCV genotypes causing
disease. Genotype 1 and 3 are globally distributed, in which
genotype 1 is the most common (46%), followed by genotype 3
(22%), genotype 2 (13%), and genotype 4 (13%).
Most of techniques previously focused on 5’UTR region (5’
untranslated region or also called 5’NC: 5’ non-coding) in
identifying quality and quantity of HCV, because of its high
conservation among different genotypes of HCV. However it only
based on 5’NC region, it is not sufficient to distinguish familiar
subtypes in the same HCV type. So, genotype identification
nowadays are based on coding regions such as core region, NS5B
region, NS4 or E1 region.