摘要： 糖尿病可使发生缺血性卒中的风险增加2 倍以上，并且合并缺血性卒中的糖尿病患者长期预后不良。目前所采取的强力降血糖治疗并未使糖尿病患者从缺血性卒中的一级和二级预防中获益。然而，有研究显示，具有针对性的缺血性卒中危险因素管理，特别是对不良生活方式、血糖、高血压、脂质代谢紊乱的干预，可预防糖尿病患者缺血性卒中的发生，并改善预后。在符合干预标准的糖尿病患者中，抗血栓治疗和颈动脉外科手术对缺血性卒中的一级和二级预防是必要的。本文拟对近年公布的糖尿病患者缺血性卒中一级和二级预防的相关证据进行概述，使临床医师了解该领域的研究现状与动态，从而更好地实施糖尿病患者的卒中预防措施。

关键词: 脑缺血, 卒中, 预防, 糖尿病

Abstract: Diabetes can cause more than double risk of ischemic stroke and is associated with with poor long-term prognosis after ischemic stroke. Surprisingly, intensively treating hyperglycemia has not been shown to have beneficial outcomes in either primary or secondary prevention in stroke disease. Encouragingly, multifactorial management of risk factors of ischemic stroke, in particular, lifestyle, glucose concentration, hypertension, and dyslipidemia will prevent a substantial number of ischemic stroke and improve the prognosis in diabetic patients. Antithrombotic treatment and carotid surgery are also essential for primary and secondary stroke prevention in selected diabetic patients. Evidence for primary and secondary prevention of ischemic stroke in diabetic patients is steadily evolving, and it is imperative that clinicians are actively informed regarding the latest advance in order to better implement stroke prevention in diabetic patients.

Key words: Brain ischemia, Stroke, Prevention, Diabetes mellitus