Flier J S, Bar R S, Muggeo M, Kahn C R, Roth J, Gorden P
J Clin Endocrinol Metab. 1978 Nov;47(5):985-95. doi: 10.1210/jcem-47-5-985.
Three patients with insulin resistance caused by autoantibodies to the insulin receptor were investigated serially over a 3-yr period. Major changes in carbohydrate metabolism, insulin receptor status, and titer of antireceptor antibodies were observed in each case. In one patient, normalization of glucose tolerance, insulin sensitivity, and receptor binding were associated with a spontaneous fall in the titer of antireceptor antibody. A second, more severely affected patient had two entirely distinct phase to her illness. The first, or hyperglycemic phase, was characterized by insulin resistance, negligible insulin binding to receptors on circulating monocytes, and high titers of circulating antireceptor antibodies. The second phase was characterized by refractory hypoglycemia, in association with proliferation of membrance insulin receptors; these occurred despite persistence of high titers of antireceptor antibody. An unusual heptic lesion, diffuse adenomatosis, was observed during this phase. A third patient showed features of both of the other patients, with spontaneous fall in antibody titer as well as a later phase of receptor proliferation. These studies demonstrate that patients with antibodies to insulin receptors may have a fluctuating clinical course. There may be spontaneous changes in antibody titers as well as independent changes in receptor concentration. Hypoglycemia and hepatic proliferation are newly recognized clinical sequelae in patients with this syndrome.
对3例因胰岛素受体自身抗体导致胰岛素抵抗的患者进行了为期3年的连续观察。在每例患者中均观察到碳水化合物代谢、胰岛素受体状态及抗受体抗体滴度的主要变化。1例患者糖耐量、胰岛素敏感性和受体结合恢复正常，同时抗受体抗体滴度自发下降。另1例病情较重的患者病程有两个完全不同的阶段。第一阶段即高血糖阶段，其特点为胰岛素抵抗、循环单核细胞上胰岛素与受体的结合可忽略不计以及循环抗受体抗体滴度高。第二阶段的特点是难治性低血糖，伴有膜胰岛素受体增生；尽管抗受体抗体滴度持续很高，但仍出现这些情况。在此阶段观察到一种不寻常的肝脏病变，即弥漫性腺瘤病。第3例患者兼有其他两例患者的特征，抗体滴度自发下降以及后期受体增生。这些研究表明，胰岛素受体抗体阳性患者的临床病程可能波动。抗体滴度可能自发变化，受体浓度也可能独立变化。低血糖和肝脏增生是该综合征患者新发现的临床后遗症。
