Idris I, Thomson G A, Sharma J C
John Pease Diabetes Centre, Sherwood Forest Hospitals NHS Trust, Nottinghamshire, UK.
Int J Clin Pract. 2006 Jan;60(1):48-56. doi: 10.1111/j.1368-5031.2006.00682.x.
The aim of this article was to describe (i) the epidemiology and outcomes of stroke relating to diabetes; (ii) the pathophysiology of diabetes as a risk factor for stroke; (iii) the management of acute stroke in patients with diabetes; (iv) the evidence of primary and secondary prevention of stroke in patients with diabetes; and (v) the risk of new-onset diabetes using older antihypertensive agents. The combination of diabetes and stroke disease is a major cause of morbidity and mortality worldwide. Evidence from large clinical trials performed in patients with diabetes supports the need for aggressive and early intervention to target patients' cardiovascular (CV) risks in order to prevent the onset, recurrence and progression of acute stroke. Identification of at-risk patients with diabetes and metabolic syndrome has also allowed the delivery of early and effective intervention to reduce stroke risks, while active treatment during the acute phase of stroke will reduce long-term neurological and functional deficits. While the ongoing debate on the risk benefits of different antihypertensive, lipid-lowering and antiplatelet agents should not detract clinicians from pursuing aggressive CV risk reduction, the application of evidence-based medicine specifically in patients with diabetes will facilitate the use of appropriate agents to improve clinical outcomes. The overall management of patients with diabetes and acute stroke or at risk of secondary stroke should also include multifactorial intervention that not only targets patient's CV risk but also includes behavioural, lifestyle and, where appropriate, surgical intervention.
（i）与糖尿病相关的中风的流行病学及转归；（ii）糖尿病作为中风危险因素的病理生理学；（iii）糖尿病患者急性中风的管理；（iv）糖尿病患者中风一级和二级预防的证据；以及（v）使用较老的抗高血压药物引发新发糖尿病的风险。糖尿病和中风疾病并存是全球发病和死亡的主要原因。在糖尿病患者中进行的大型临床试验的证据支持，有必要进行积极的早期干预，以针对患者的心血管（CV）风险，从而预防急性中风的发生、复发和进展。识别有风险的糖尿病和代谢综合征患者，也有助于进行早期有效的干预以降低中风风险，而在中风急性期进行积极治疗将减少长期的神经和功能缺陷。尽管关于不同抗高血压药、降脂药和抗血小板药物的风险效益的持续争论不应妨碍临床医生积极降低心血管风险，但将循证医学专门应用于糖尿病患者将有助于使用合适的药物来改善临床结局。糖尿病和急性中风患者或有二次中风风险患者的整体管理还应包括多因素干预，这不仅要针对患者的心血管风险，还应包括行为、生活方式干预，并在适当时进行手术干预。
