Обсервационное исследование на основе данных NHANES: связь суррогатных маркеров инсулинорезистентности с общей и сердечно-сосудистой смертностью у лиц с кардиометаболическими заболеваниями

Введение: Кардиометаболические заболевания (КМЗ) представляют собой одну из важнейших проблем мирового здравоохранения. Суррогатные маркеры инсулинорезистентности (ИР) позволяют прогнозировать прогрессирование КМЗ, однако имеющиеся данные об их прогностической значимости в отношении смертности при КМЗ противоречивы. В данном исследовании изучалась связь между шестью суррогатными маркерами ИР и смертностью от всех причин и от сердечно-сосудистых заболеваний (ССЗ) у пациентов с КМЗ, а также проводилась оценка прогностической значимости этих суррогатных маркеров.
Материал и методы: Проанализированы данные 2 944 пациентов с КМЗ. Для оценки связи между суррогатными маркерами ИР и показателями общей смертности, а также смертности от сердечно-сосудистых заболеваний (ССЗ) использовались модели пропорциональных рисков Кокса и ограниченные кубические сплайны. Оценивались следующие маркеры: 1) расчетная скорость утилизации глюкозы (eGDR), 2) индекс висцерального ожирения (ИВО), 3) Триглицерид-глюкозный индекс (TyG), 4) Триглицерид-глюкозный индекс массы тела (TyG-BMI), 5) метаболический индекс инсулинорезистентности (METS-IR), 6) атерогенный индекс плазмы (АИП). Для сравнения прогностической значимости маркеров ИР применялся анализ ROC-кривых.
Результаты: Среди пациентов с КМЗ показатели eGDR, ИВО, TyG, TyG-BMI, METS-IR и АИП ассоциировались со смертностью от всех причин (все p<0,050), причем TyG-BMI и METS-IR обладали наибольшей прогностической эффективностью (AUC: 0,743 и 0,743, соответственно). Показатели TyG и АИП ассоциировались со смертностью от ССЗ (оба p<0,050) и также продемонстрировали прогностическую эффективность (AUC: 0,734 и 0,733, соответственно).
Заключение: В популяции пациентов с КМЗ показатели TyG-BMI и METS-IR обладали наибольшей прогностической значимостью в отношении смертности от всех причин. Показатели TyG и AIP продемонстрировали прогностическую эффективность в отношении смертности от ССЗ. 

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