ometendoОжирение и метаболизмObesity and metabolism2071-87132306-5524Endocrinology Research Centre10.14341/omet10082ometendo-10082Research ArticleОбзор литературыReviewВозможности и варианты суррогатной оценки инсулинорезистентностиOpportunities and options for surrogate assessment of insulin resistancehttps://orcid.org/0000-0002-6762-5238РуяткинаЛюдмила АлександровнаRuyatkinaLyudmila A.

Доктор медицинских наук, профессор кафедры неотложной терапии с эндокринологией и профпатологией ФПК и ППв ФГБОУ ВО НГМУ; эндокринолог - консультант ГБУЗ НСО ГКБ№1

 

MD, ScD, professor; endocrinologist - consultant

larut@list.ruhttps://orcid.org/0000-0003-3431-5943РуяткинДмитрий СергеевичRuyatkinDmitry S.

Кандидат медицинских наук, доцент кафедры неотложной терапии с эндокринологией и профпатологией факультета повышения квалификации и профессиональной переподготовки врачей

MD, PhD, associate professor 

dr79@mail.ruИсхаковаИрина СергеевнаIskhakovaIrina S.

Кандидат медицинских наук, врач-эндокринолог

MD, PhD

tyutyunjon@mail.ru<p>ФГБОУ ВО &laquo;Новосибирский государственный медицинский университет&raquo; Министерства Здравоохранения РФ; ГБУЗ Новосибирской области &laquo;Городская клиническая больница №1&raquo;</p>Россия<p>Novosibirsk State Medical University; Novosibirsk Clinical Hospital №1</p>Russian Federation<p>ФГБОУ ВО &laquo;Новосибирский государственный медицинский университет&raquo; Министерства Здравоохранения РФ</p>Россия<p>Novosibirsk State Medical University</p>Russian Federation<p>ГБУЗ Новосибирской области &laquo;Городская клиническая больница №1&raquo;</p>Россия<p>Novosibirsk Clinical Hospital №1</p>Russian Federation2019200620191612733Copyright &#x00A9; Руяткина Л.А., Руяткин Д.С., Исхакова И.С., 20192019Руяткина Л.А., Руяткин Д.С., Исхакова И.С.Ruyatkina L.A., Ruyatkin D.S., Iskhakova I.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.omet-endojournals.ru/jour/article/view/10082

Высокая распространенность сахарного диабета 2 типа (СД2) и атеросклеротических сердечно-сосудистых заболеваний (ССЗ) определяет необходимость раннего выявлением и коррекции ключевых маркеров кардио-метаболического риска (КМР). Это профилактическое направление тесно связано с метаболическим синдромом (МС) на основе концепции инсулинорезистентности (ИР). Одновременно ИР является первым звеном патогенеза СД2 и признанным фактором риска атеротромбоза. Поэтому ранняя диагностика ИР имеет практическое значение как для выявления ранних нарушений углеводного обмена (НУО) и прогноза СД2, так и кардиологического риска.

Предложены альтернативные показатели для оценки ИР с включением липидных и антропометрических параметров, диагностическая и прогностическая значимость которых в плане КМР (НУО и ССЗ) оценена в рандомизированных клинических исследованиях в сравнении с индексом HOMA-IR и клэмп-тестом. Индекс TyG (с расчётом на основе глюкозы плазмы и триглицеридов) согласуется с феноменом глюкозолипотоксичности с последующими метаболическими нарушениями в органах-мишенях. Предложены его производные: TyG-WC (TyG/окружность талии) и TYG-BMI (TyG/ИМТ). Применяют индексы LAP (показатель аккумуляции липидов) и VAI (индекс висцерального ожирения), а также TG/HDL (ТГ/ЛПВП). Выявлены их этнические и гендерные различия, сделаны попытки расчета отрезных точек для этих индексов.

The high prevalence of type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular diseases (CVD) determines the need for early detection and correction of key markers of cardio-metabolic risk (CMR). This prophylactic direction is closely related to metabolic syndrome (MS) based on the concept of insulin resistance (IR). At the same time, IR is the first link in the pathogenesis of T2DM and is a recognized risk factor for atherothrombosis. Therefore, early diagnosis of IR is of practical importance both for the detection of early disorders of carbohydrate metabolism (DCM) and prognosis of T2DM, and cardiological risk. Alternative indicators have been proposed for evaluating IR with the inclusion of lipid and anthropometric parameters, the diagnostic and prognostic significance of which in terms of CMR (DCM and CVD) has been evaluated in randomized clinical trials in comparison with the HOMA-IR index and clamp. The TyG index (calculated on the basis of plasma glucose and triglycerides) is consistent with the phenomenon of glucolipotoxicity with subsequent metabolic disorders in target organs. Its derivatives are proposed: TyG-WC (TyG / waist circumference) and TYG-BMI (TyG / BMI). Apply LAP indices (lipid accumulation index) and VAI (visceral obesity index), as well as TG / HDL (TG / HDL). Their ethnic and gender differences were revealed, attempts were made to calculate the cut-off points for these indices.

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The authors declare that there are no conflicts of interest present.