用数学改写乙肝临床治疗指南

报 告 人：沈明望 教授

报告时间：2026年9月17日 15:30

报告地点：南校区理科楼307会议室

主办单位：数学与统计学院

报告人简介：

沈明望，现任西安交通大学公共卫生学院流行病与卫生统计学系，教授/博士生导师，陕西省疾病防控与健康促进研究重点实验室副主任。2017年12月在西安交通大学数学与统计学院获得应用数学博士学位。2015年至2017年在美国德克萨斯大学奥斯汀分校生物统计系公派交流学习两年。入选陕西省青年拔尖人才、陕西省高校科协青年人才托举计划，曾获中国妇幼健康科学技术奖二等奖（科技成果奖）、西安交通大学“十大学术新人”奖、“医工交叉十大创新新人”、“十大青年岗位能手”、“冯博琴人工智能奖教金”创新奖（二等奖）、“徐宗本应用数学论文奖”(一等奖)。主要研究方向为传染病动力学建模、生物数学、理论流行病学、人工智能在医学中的应用、卫生经济学评价等交叉学科研究。主持项目15项，包括国家自然科学基金面上项目（2项）和青年基金项目等。已发表SCI论文101篇，其中第一作者/通讯作者49篇，包括Journal of Hepatology（编辑精选论文）、Lancet HIV（封面论文）、Nature Communications、The Innovation（2篇）、BMC Medicine（3篇）、Lancet Regional Health-Western Pacific（2篇）等。成果被选为世界卫生组织发布指南的卫生经济学证据、欧洲肝病学会乙肝病毒感染管理临床实践指南修订的建模证据以及《儿童慢性乙型肝炎防治专家共识》的建模证据。担任Lancet Microbe期刊统计学编辑、BMC Medicine期刊编委、Pharmacoeconomics and Policy期刊编委、中国抗癌协会肿瘤流行病学专业委员会委员、中国疫苗行业协会疫苗经济学专业委员会委员等。

内容摘要：

Background & Aims: The risk of mother-to-child transmission for pregnant women with chronic hepatitis B (CHB) still exists,especially for those with high HBV DNA levels. The guidelines for initiating prophylaxis for pregnant women with CHB vary acrosscountries. We aimed to explore the latest prophylaxis initiation time for these women.

Methods: We collected the real-world clinical data of 328 pregnant women aged 20-49 with CHB, who were treated with telbivudine or tenofovir disoproxil fumarate, from July 2010 to December 2020 in China. A mathematical model was developed to describe the viral kinetics of HBV after prophylaxis. We calculated the time required to reduce viral load below the threshold value of 5.3 log10 IU/ml. We derived the prophylaxis initiation time by subtracting the required time to threshold from the childbirth gestational week.

Results: The median time for 328 women to reduce HBV DNA levels below the threshold of 5.3 log10 IU/ml was 4.2 (range: 0.2-12.8) weeks, corresponding to a prophylaxis initiation time of no later than 35.1 (25.2-41.4) weeks. Specifically, for women with viral loads >8.0 log10 IU/ml, prophylaxis should be initiated before 33.9 (25.2-39.5) weeks, and even before the lower bound of 25.2 weeks, to maximize clinical safety. For women with viral load >7.0 to <−8.0 log10 IU/ml, prophylaxis should be initiated before 35.5 (28.6-39.8) weeks, and for women with viral load >5.3 to <−7.0 log10 IU/ml, prophylaxis should be initiated before 36.2 (28.3-41.4) weeks.

Conclusion: Pregnant women with HBV DNA levels >5.3 to <−8.0 log10 IU/ml can initiate prophylaxis before 28 gestational weeks. However, women with HBV DNA >8.0 log10 IU/ml could consider initiating prophylaxis before 25 weeks..

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