Comparison of efficacy of sequential therapy using daravone dextrocamphorol combined with buphenphthalein in patients with acute cerebral infarction with different CYP2C19 genotypes
Li Haiyun
Wu Xing
Guo Jiali
Wang Xiaoyan
Wang Limin
Gao Zhongsheng
Abstract：Objective To compare the efficacy of sequential therapy using edaravone dexborneol(EDB)combined with bu-tylphthalide(NBP)in acute cerebral infarction(ACI)patients with different CYP2C19 genotypes.Methods A total of 122 ACI patients admitted to Zhangjiakou First Hospital from January 2021 to December 2023 were selected and grouped according to the results of CYP2C19 genotyping.Among them,the rapid metabolism group accounted for 44.26%(54/122),the medium metabolism group for 41.80%(51/122)and the slow metabolism group for 13.94%(17/122).All the patients in the three groups were treated with EDB combined with NBP for 2 weeks.The neurological function(National Institutes of Health Stroke Scale(NIHSS)score,S100 calcium binding protein-β(S100-β)level),efficacy,vascular endothelial function(endothelin-1(ET-1),vascular endothelial growth factor(VEGF)and nitric oxide(NO)),oxidative stress indexes(malondialdehyde(MDA),vascular endothelial growth factor(VEGF)and nitric oxide(NO))were compared among the three groups.Superoxide dismutase(SOD),reactive oxygen species(ROS)and adverse reactions were also counted and compared among the three groups.Results After treatment,NIHSS scores and S100-β levels decreased in all the three groups.Moreover,they were lower in the rapid metabolism group((6.26±1.20)points,(0.98±0.11)μg·L-1)than in the medium metabolism group((7.21±1.57)points,(1.11±0.24)μg·L-1)and slow metabolism group((9.06±1.66)points,(1.23±0.26)μg·L-1)in order,showing statistical significant difference(F=25.320,12.334,both P<0.05).The total effective rate was 96.30%(52/54)in the rapid metabolism group,which was higher than that of 76.47%(13/17)in the slow metabolism group(χ2=6.098,P<0.05).The ET-1 lev-el was decreased in all the three groups after treatment and it was lower in the rapid metabolism group((44.11±5.30)ng·L-1)than in the medium metabolism group((48.77±5.60)ng·L-1)and the slow metabolism group((54.31±6.22)ng·L-1)in order.The VEGF and NO lev-els were increased in all the three groups.They were higher in the rapid metabolism group((17.04±2.35)ng·L-1,(5.44±0.83)μg·L-1)than in the medium metabolism group((15.90±2.68)ng·L-1,(4.93±0.71)μg·L-1)and the slow metablism group((14.37±2.76)ng·L-1,(4.41±0.92)μg·L-1)in order(F=24.138,7.661,11.693,all P<0.05).The levels of MDA and ROS were decreased in all the three groups.They were lower in the rapid metabolism group((5.94±2.00)ng·L-1,(120.80±15.39)U·mL-1)than in the medium metabolism group((7.50±2.46)ng·L-1,(134.57±16.02)U·mL-1)and the slow metabolism group((8.78±2.32)ng·L-1,(143.51±17.29)U·mL-1)in order.The SOD level was increased in all the three groups after treatment.It was higher in the rapid metabolsim group((114.86±15.05)U·mL-1)than in the medium metabolism group((102.61±14.14)U·mL-1)and the slow metabolism group((95.01±13.80)U·mL-1)in order and the difference was statistically significant(F=12.606,17.216,16.064,all P<0.05).The total adverse reaction rate was 3.70%(2/54)in the rapid metabolism group and 23.53%(4/17)in the slow metabolism group,showing statistically significant differ-ence(χ2=6.261,P<0.05).Conclusion The efficacy of EDB combined with NBP sequential therapy in different CYP2C19 genotype ACI patients is different.The ACI patients with rapid metabolism genotype have the best neurological function recovery,vascular endothelial function and oxidative stress improvement,and the highest drug safety.
Keywords：Acute cerebral infarctionEdaravone dexborneolButylphthalideCYP2C19 genotypeOxidative stress
Publication Date：2025-06-25
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 504-509 )