de Bruin T W, Bussemaker J K, Heidema J, Hermans J, van der Heide D
Department of Endocrinology, Leiden University, University Hospital, The Netherlands.
J Clin Endocrinol Metab. 1988 Oct;67(4):676-81. doi: 10.1210/jcem-67-4-676.
In Graves' disease (GD), an antireceptor autoantibody disease, individual variability in the pathogenic interaction between TSH receptors and autoantibodies has been reported. This variability can be due to allotypic (person to person) variability in the receptors or differences in autoantibody amount or specificity. This fundamental issue was investigated by evaluating immunoglobulin G (Ig)-induced TSH receptor modulation in thyroid tissue from 19 patients with GD. TSH receptor modulation by Graves' Ig was defined as the appearance of 1 class of high affinity binding sites, instead of the usual 2 classes of binding sites. Ig-induced modulation of receptors occurred in 9 of 19 (47%) experiments with autologous (patient's own) tissues and correlated with the presence of TSH receptor antibodies, measured as TSH binding inhibitor Igs. Of these 9 receptor-modulating Graves' Ig preparations, 7 (78%) also had a receptor-modulating effect in other patient's (homologous) thyroid tissue. Nine of the 10 Graves' Ig preparations that were negative for TSH receptor-modulating activity in autologous thyroid tissue were tested with other patients' thyroid tissues; 7 (78%) were negative, and all were TSH binding inhibitor Ig negative. We conclude that variability in the occurrence of TSH receptor modulation was associated with the presence or absence of TSH-binding inhibitor Ig. No evidence for allotypic differences in TSH receptors in GD was found.
在格雷夫斯病（GD），一种抗受体自身抗体疾病中，已报道促甲状腺激素（TSH）受体与自身抗体之间致病相互作用存在个体差异。这种差异可能是由于受体的同种异型（人与人之间）差异，或自身抗体数量或特异性的不同。通过评估19例GD患者甲状腺组织中免疫球蛋白G（Ig）诱导的TSH受体调节，对这一基本问题进行了研究。格雷夫斯Ig对TSH受体的调节定义为出现1类高亲和力结合位点，而不是通常的2类结合位点。在19个使用自体（患者自身）组织的实验中，有9个（47%）出现了Ig诱导的受体调节，且与TSH受体抗体的存在相关，TSH受体抗体以TSH结合抑制Ig来衡量。在这9种具有受体调节作用的格雷夫斯Ig制剂中，7种（78%）在其他患者的（同种）甲状腺组织中也有受体调节作用。对10种在自体甲状腺组织中TSH受体调节活性为阴性的格雷夫斯Ig制剂，用其他患者的甲状腺组织进行检测；7种（78%）为阴性，且均为TSH结合抑制Ig阴性。我们得出结论，TSH受体调节发生的差异与TSH结合抑制Ig的存在与否相关。未发现GD中TSH受体存在同种异型差异的证据。
