| Background:Diabetes is a common endocrine metabolic disease which characterized by absolute or relative lack of insulin and the lower sensitivity to insulin of target cells. The complications of diabetes can affect multiple body systems, gastrointestinal tract is involved,30%-76% of diabetes patients have gastrointestinal symptoms in different degrees. IBS is a common functional intestinal disorder which characterized by abdominal pain or discomfort accompanying defecate changes. Diabetes complicated with constipation type IBS is one of the diabetic gastrointestinal dysfunction. It has a significant adverse impact on a person’s quality life, but there are still no study about mental states and the pathogenesis of overlapped syndrome patients.Interstitial cells of Cajal (ICC) are the pacemaker cells of gastrointestinal tract, the decrease, missing and ultrastructure damage of ICC is one of the important reasons for the diabetic gastrointestinal disorders which has become a new research direction in the field of gastrointestinal dynamics. It has been found that ICC changes in many kinds of gastrointestinal movement disorders and it has been defined as the pathological reason of diabetic gastroparesis. But there is no report about living status of ICC in patients of diabetes overlapped constipation type IBS, thus, we studied this aspect. SCF is a kind of important multifunctional growth factor and it is the natural ligand of c-kit (tyrosine kinase receptors), which is the specific marker of ICC. It forms the SCF-Kit signaling pathway with Kit. It is necessary for the development and phenotype of Kit positive cells such as ICC. ICC’s missing is accompanied by SMC atrophy and SCF decreased expression in diabetic patients. Research has shown that lower SCF expression may be the direct cause of the ICC’s decreased number and abnormal ultrastructure.IGF-1 is a single-chain polypeptide composed with 70 amino-acids peptide which belongs to the family of insulin-like growth factor. Its relative molecular mass is about 7.7 kDa, encoding genes located on human chromosome 12. It was mainly secreted by liver to play regulatory role both insulin-like function involving physiological and pathological aspects by binding to IGF-1 receptors on the surface of target cells. The stem cell factor (SCF) expressed by gastrointestinal smooth muscle cells (SMC) can be induced by IGF-1, which is conducive to the survival of the ICC. Under the diabetic situation, the weak insulin/IGF-1 signaling would result in SCM atrophy and decreased SCF expression, which lead to the loss of ICC and the cell function of it is also affected.Complications of diabetes, high blood sugar, lower quality of life, increased body mass index are the major factors of anxiety and depression in diabetic patients. In a state of negative psychology for a long time will badly influence their self-care behavior, medication, diet, medical expenses, etc. The pathogenesis of IBS is closely related to mental psychological factors. Negative psychology changes the ghrelin levels in the body through brain-gut axis, which would cause movement disorders or allergic reactions in gastrointestinal system, and ultimately lead to bowel disorders. There was no literature reported the psychological change of patients with these two diseases all over the world, so it is necessary to better understand the psychological status of patients with diabetes overlapped constipation type IBS, and to analyze the role of it in concurrent disease.Aim:The aim of study was to compare the psychological status of pre-diabetes, diabetes in constipation type irritable bowel syndrome (IBS) cases and matched controls. The pathogenesis of the overlapped disease had also been discussed.Methods:From April 2013 to June 2014,256 patients with type 2 diabetes and/or constipation type irritable bowel syndrome and 30 healthy controls recruited from gastroenterology clinic and endocrinology unit of Northern Jiangsu Peoples Hospital was performed on the epidemiological survey. Anxiety Disorder-7 Questions (GAD-7) and Patient Health Questionnaire-9 Questions (PHQ-9) were used to evaluate the symptoms of mental health in this study. The levels of fasting plasma insulin-like growth factor I (IGF-I) and stem cell factor (SCF) were examined using an enzyme-linked immunosorbent assay (ELISA) in 164 participants who are willing to provide blood samples. Single factor analysis of variance LSD test and chi-square test were performed for statistical analysis.Results:The proportion of patients with diabetes overlapped constipation type IBS (46.53%) who suffered sleep disorder is significantly higher (P<0.05) than diabetic (23.08%). The clinical symptoms associated with neurological dysfunction are more common in the group of diabetes overlapped constipation type IBS. The pre-diabetes overlapped constipation type IBS group reported significantly higher scores of GAD-7 than diabetes group (P<0.05) and controlled group (P<0.05), but it was not obviously different from that in diabetes overlapped constipation type IBS group (P>0.05). The pre-diabetes overlapped constipation type IBS group (P<0.05) and diabetes overlapped constipation type IBS group (P<0.05) reported significantly higher scores of PHQ-9 than constipation type IBS group, but there was no significant difference between constipation type IBS group and controlled group (P>0.05). The GAD-7 scores of patients whose courses of diabetes less than 1 year (8.00±3.86) were significantly higher (P<0.05) than those had diabetes for at least 5 years (5.20±3.23). Compared to controlled group (242.61±13.40), reduced IGF-1 (P＜0.001 and P＜0.001, respectively) were detected in pre-diabetes with constipation type IBS group (170.20±34.55) and diabetes with constipation type IBS group (154.24±18.81). Compared to controlled group (402.11±55.51), reduced SCF (P<0.05 and P<0.05, respectively) were detected in pre-diabetes with constipation type IBS group (324.24±83.37) and diabetes with constipation type IBS group (317.29±79.30).Conclusion:To some extent, ICC depletion caused by the reduced plasma IGF-1 and SCF levels explained pathogenic mechanisms of symptoms of constipation type IBS in diabetes mellitus. Thus, the overlapping symptoms may be correlated with sleep pattern, diabetic course, psychological disorder. |
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