本實驗目的在探討肥胖相關因子：身體質量指數、高血脂、糖尿病或糖尿病前期、高敏感性C反應蛋白、空腹血漿胰島素、空腹血漿血糖、胰島素阻抗指數和葛瑞夫氏症眼病變的關係。總共42位葛瑞夫氏症有眼病變者和42位葛瑞夫氏症無眼病變者收錄在此橫斷性研究中。收錄病人的性別、年齡、葛瑞夫氏症治療的時間、身高、體重、腰圍、抽菸狀態、共病症、血中游離甲狀腺素、甲狀腺刺激素、空腹血漿胰島素和血糖、甲狀腺刺激素受體抗體、高敏感性C反應蛋白。眼睛評估是依據歐洲葛瑞夫氏症眼病變群共識聲明和NOSPECS分類。本篇研究發現在多變量二元邏輯迴歸分析：身體質量指數、空腹血漿胰島素、胰島素阻抗指數跟是否有葛瑞夫氏症眼病變有關即使在調整性別、年齡、抽菸、甲狀腺刺激素受體抗體和類固醇使用(依序為校正後勝算比1.182, 95% 信賴區間，1.003-1.393，p值0.046；校正後勝算比 1.165, 95% 信賴區間 1.001-1.355，p值0.048; 校正後勝算比1.985， 95% 信賴區間 1.046-3.764，p值0.036)。另外身體質量指數、空腹血漿胰島素值、空腹血漿血糖值、胰島素抗阻指數和高敏感性C反應蛋白與葛瑞夫氏症眼病變的嚴重度有正相關（分別為相關係數 0.285，p = 0.009；相關係數 0.243， p = 0.026；相關係數 0.298，p = 0.006； 相關係數 0.270，p = 0.013；相關係數0.299，p = 0.006）。 在眼眶脂肪纖維母細胞培養實驗以胰島素濃度0.1 ng/mL、0.5 ng/mL、2 ng/mL、1000 ng/mL時脂肪形成做比較，脂肪生成分別為0.438+0.053、0.433+0.017、0.549+0.050、0.653+0.053 p=0.038具有顯著差異。本研究可見肥胖相關因子，特別是空腹血漿胰島素、胰島素阻抗指數和葛瑞夫氏症眼病變有關聯。本研究顯示肥胖相關因子在葛瑞夫氏症眼病變的重要性，兩者間的相互關係仍需探討。

The purpose of this study was to explore the relationships between obesity-related factors including body mass index, hyperlipidemia, prediabetes or diabetes, high sensitive C-reactive protein, fasting plasma insulin, fasting plasma glucose, homeostasis model assessment-estimated insulin resistance, and Graves’ orbitopathy. Forty-two patients with Graves’ orbitopathy and forty-two patients with Graves’ disease but without orbitopathy were enrolled in this observation and cross-sectional study. Age, gender, Graves’ disease treatment history, waist circumference, body weight, height, co-morbidities, smoking status, levels of free thyroxin, thyroid-stimulating hormone, thyroid-stimulating hormone receptor antibodies, fasting plasma insulin and glucose, and high-sensitive C-reactive protein were recorded. Eye condition was evaluated by the NOSPECS classification and consensus statement of the European Group of Graves’ Orbitopathy. Results of this study using multivariate regression analysis revealed that body mass index, fasting plasma insulin, and homeostasis model assessment-estimated insulin resistance had an association with the presence of Graves’ Orbitopathy after adjusting the gender, age, smoking habit, thyroid-stimulating hormone receptor antibodies, and steroid usage with adjusted odd’s ratio 1.182, 95% confidence interval, 1.003-1.393, p=0.046; adjusted odd’s ratio 1.165, 95% confidence interval, 1.001-1.355, p=0.048; and adjusted odd’s ratio 1.985, 95% confidence interval, 1.046-3.764, p=0.036, respectively. Furthermore, body mass index, fasting plasma insulin, fasting plasma glucose, Homeostasis model assessment-estimated insulin resistance and high-sensitive C-reactive protein levels were correlated with the severity of Graves’ Orbitopathy positively (rho = 0.285, p = 0.009；rho = 0.243, p = 0.026；rho = 0.298, p = 0.006； rho = 0.270, p = 0.013；rho = 0.299, p = 0.006, respectively). Adipogenesis was different at medium containing insulin in concentration of 0.1 ng/mL、0.5 ng/mL、2 ng/mL and 1000 ng/mL, the results were 0.438+0.053, 0.433+0.017, 0.549+0.050, 0.653+0.053, p=0.038, respectively in the culture of fibroblast from orbital fat. Our findings suggest that obesity-related factors, especially body mass index, fasting plasma insulin and homeostasis model assessment-estimated insulin resistance, are related to Graves’ Orbitopathy. The relationship between obesity-related factors and Graves’ Orbitopathy needs further study to explore.

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