J Vis Exp. 2026 May 5;(231). doi: 10.3791/69165.
ABSTRACT
To investigate the prognosis of patients with acute-phase cerebral infarction treated with butylphthalide based on cytochrome P450 2C19 (CYP2C19) genotype. A total of 175 patients with acute cerebral infarction treated with butylphthalide at our hospital from January 2022 to January 2025 were retrospectively enrolled. Based on modified Rankin Scale (mRS) scores at 3 months post-treatment, patients were categorized into a good prognosis group (mRS ≤2) and a poor prognosis group (mRS ≥3). CYP2C19 genotypes and metabolic phenotypes were analyzed. Clinical data and genotype distributions were compared between groups, and logistic regression analysis was performed to identify prognostic factors. Intermediate metabolizers predominated (46.29%), while poor metabolizers were the least common (12.00%). Compared to the good prognosis group, the poor prognosis group exhibited a significantly higher prevalence of hypertension (P <0.05), elevated serum homocysteine (Hcy) levels (P <0.05), and higher baseline National Institutes of Health Stroke Scale (NIHSS) scores (P <0.05). Poor metabolizers (CYP2C19*2/*2, *2/*3, *3/*3) were overrepresented in the poor prognosis group, whereas rapid metabolizers (CYP2C19*1/*1) were more frequent in the good prognosis group (P <0.05). Logistic regression analysis identified three independent predictors of poor prognosis after controlling for covariates: elevated homocysteine levels (odds ratio (OR) = 2.255; 95% CI: 1.404-3.622; P < 0.001), higher baseline NIHSS score (OR = 3.127; 95% CI: 1.508-6.482; P = 0.002), and CYP2C19 poor metabolizer status (OR = 4.559; 95% CI: 2.392-8.688; P < 0.001). Elevated Hcy levels, increased NIHSS scores, and CYP2C19 poor metabolizer phenotypes are significant prognostic factors in butylphthalide-treated acute cerebral infarction. Patients with poor metabolizer genotypes exhibit worse outcomes, highlighting the need for personalized treatment strategies to optimize outcomes.
PMID:42184267 | DOI:10.3791/69165