Abstract：
Ischemic stroke (IS) is often comorbid with type 2 diabetes mellitus (T2DM) wherein the determinants of long-term outcomes, beyond the acute stroke phase, are not adequately known. This study identified the determinants of long-term outcomes for diabetic IS patients through a prospective nested case-control study in 624 patients treated with conservative measures (38.60% females, mean age: 63.85 years). After 36-month follow-up, 117 (18.8%) patients with poor outcome were enrolled in the case group. The poor outcome was defined with a modified Rankin Scale (mRS) score ≥3. Meanwhile, 374 (59.9%) patients with good outcome, defined as (mRS score <3), were included in the control group. Patients who died (n = 32) or lost to follow-up (n = 101) were excluded in analysis. Poor prognostic outcome was positively associated with (1) the pulse rate at admission, (2) diastolic blood pressure (DBP), and (3) fasting blood glucose (FBG) during follow-up, whereas physical activity and lipid-lowering treatment during follow-up were negatively associated. Importantly, a forecasting model with these indicators distinguished the patients with good versus poor outcomes with 70.1% sensitivity and 73.5% specificity. Health care professionals and laboratory medicine scholars may want to monitor an increase in DBP and FBG during follow-up, as well as physical activity and lipid-lowering treatment, in relationship to the prognosis of IS with comorbid T2DM after conservative therapies. The proposed predictive model for personalized/precision medicine requires field testing in independent studies, and might help risk stratification with theranostic tests for patients with acute IS who also have a diagnosis of T2DM.
摘要：
缺血性卒中（IS）通常与2型糖尿病（T2DM）并存，其中长期结局的决定因素，超过急性中风阶段，没有足够的了解。本研究通过一项前瞻性巢式病例对照研究确定了糖尿病IS患者长期结局的决定因素，该研究在624例接受保守治疗的患者中进行了研究（38.60％为女性，平均年龄：63.85岁）。经过36个月的随访，117例（18.8%）预后不良的患者纳入病例组。不良结果定义为改良的Rankin量表（mRS）评分≥3。同时,374例（59.9％）患者预后良好，定义为（MRS评分<3），纳入对照组。在分析中排除死亡（n=32）或失去随访（n=101）的患者。预后不良与（1）入院时的脉搏率呈正相关，（2）舒张压（DBP），（3）随访期间空腹血糖（FBG），而随访期间的体力活动和降脂治疗呈负相关。重要的是,具有这些指标的预测模型以70.1%的敏感性和73.5%的特异性区分了预后良好和不良的患者.卫生保健专业人员和实验室医学学者可能希望在随访期间监测DBP和FBG的增加，以及体力活动和降脂治疗，与保守治疗后IS合并T2DM的预后相关。拟议的个性化/精准医疗预测模型需要在独立研究中进行现场测试，并且可能有助于对同时诊断为T2DM的急性IS患者进行治疗诊断的危险分层。
