Проблема оценки уровня соматической коморбидности у пациентов с рекуррентным депрессивным расстройством и биполярным расстройством: метаболический синдром, сердечно-сосудистые заболевания и сахарный диабет II типа

Негативное влияние депрессии на течение и исход соматической патологии хорошо известно, однако, остается малоизученным вопрос о том, как соматические заболевания влияют на клиническую картину, течение и прогноз депрессии. Нет четкого представления о реальном уровне коморбидности соматических заболеваний у пациентов с депрессией, связи коморбидности с клиническими особенностями заболевания, возрастом и полом пациентов, а также с диагностическими вариантами депрессии. Наиболее распространенными вариантами соматической коморбидности с высоким уровнем инвалидизации и значительным вкладом в показатели смертности считаются метаболический синдром (МС), сердечно-сосудистые заболевания (ССЗ) и сахарный диабет II типа (СД2). Все эти заболевания и состояния тесно связаны с депрессией общими патофизиологическими механизмами нейро-иммунометаболической и кардио-метаболической природы. Воспалительные процессы и факторы генетического риска играют важнейшую роль в работе этих механизмов. Цель: проанализировать существующие научные данные о частоте встречаемости МС, ССЗ и СД2 у пациентов с РДР и БАР в сравнительном аспекте с учетом возможных эффектов пола и возраста, а также выделить специфические клинические особенности коморбидных пациентов. Материал и методы: Проведен анализ научной литературы по теме коморбидности РДР и БАР с МС, ССЗ и СД2. Для анализа отбирались преимущественно метаанализы и проспективные исследования с большими объемами изучаемых выборок. Результаты: По данным современных исследований МС обнаруживается в среднем у 30-35% пациентов как с БАР, так и с РДР с небольшим превалированием пациентов мужского пола. ССЗ выявляются в среднем у 18-20% пациентов с БАР и у 25-45% пациентов с РДР также с некоторым преобладанием пациентов мужского пола. СД2 имеется в среднем у 8-10% пациентов как с БАР, так и с РДР без различий по полу. Ни для БАР, ни для РДР не выявлены воспроизводимые и специфические клинические особенности коморбидных пациентов по сравнению с пациентами без коморбидности. Заключение: Необходимы дальнейшие исследования проблемы коморбидности депрессии и хронических соматических заболеваний, особенно с учетом отсутствия научных данных для российской популяции.

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