OBJECTIVE Although patients with type 1 diabetes have a poor prognosis after a stroke, predictors of survival after an incident stroke in these patients are poorly studied.

RESEARCH DESIGN AND METHODS In this observational study, a total of 144 patients of 4,083 with type 1 diabetes from the Finnish Diabetic Nephropathy (FinnDiane) Study suffered an incident stroke in 1997–2010, and were followed for a mean 3.4 ± 3.1 years after the stroke. Information was recorded on hard cardiovascular events and death as a result of cardiovascular or diabetes-related cause, collectively referred to as vascular composite end point. Information was collected from medical records, death certificates, and the National Care Register of Health Care. Predictors at the time of the incident stroke were studied for the end points.

RESULTS During follow-up, 104 (72%) patients suffered a vascular composite end point. Of these, 33 (32%) had a recurrent stroke, 33 (32%) a hard cardiovascular event, and 76 (53%) died of cardiovascular or diabetes-related causes, with an overall 1-year survival of 76% and 5-year survival of 58%. The predictors of a vascular composite end point were hemorrhagic stroke subtype (hazard ratio 2.03 [95% CI 1.29–3.19]), as well as chronic kidney disease stage 2 (2.48 [1.17–5.24]), stage 3 (3.04 [1.54–6.04]), stage 4 (3.95 [1.72–9.04]), and stage 5 (6.71 [3.14–14.34]). All-cause mortality increased with deteriorating kidney function.

CONCLUSIONS Patients with type 1 diabetes with an incident stroke have a poor cardiovascular prognosis and a high risk of all-cause mortality. In particular, hemorrhagic stroke subtype and progression of diabetic kidney disease conveys worse outcome.

目的尽管1型糖尿病患者的中风后预后较差，但对这些患者中风后存活的预测指标研究较少。

研究设计和方法在这项观察性研究中，来自芬兰糖尿病肾病（FinnDiane）研究的144例4,083例1型糖尿病患者在1997–2010年发生了中风，在随访之后平均随访3.4±3.1年。中风。记录了有关由于心血管或糖尿病相关原因而导致的硬性心血管事件和死亡的信息，这些原因统称为血管复合终点。信息是从医疗记录，死亡证明和国家医疗保健登记簿中收集的。研究了发生中风时的预测指标作为终点。

结果在随访期间，有104名（72％）患者出现了血管复合终点。其中33例（32％）患有中风复发，33例（32％）患有严重的心血管事件，76例（53％）死于心血管或糖尿病相关原因，总体1年生存率分别为76％和5年生存率为58％。血管复合终点的预测因素是出血性中风亚型（危险比2.03 [95％CI 1.29-3.19]），以及慢性肾脏病第2阶段（2.48 [1.17-5.24]），第3阶段（3.04 [1.54– 6.04]），第4阶段（3.95 [1.72–9.04]）和第5阶段（6.71 [3.14–14.34]）。全因死亡率随肾功能恶化而增加。

结论发生中风的1型糖尿病患者的心血管预后较差，全因死亡率较高。尤其是出血性中风亚型和糖尿病肾病的进展会带来更差的结果。