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. 2022 Feb 16:15:1703-1713.
doi: 10.2147/IJGM.S333836. eCollection 2022.

Efficacy of Freeze-Dried Amnion Grafts on Cytokines in Uterine Exudates Following Hysteroscopic Adhesiolysis of Severe Intrauterine Adhesions

Sha Wang  1 , Hua Duan  1 , Bohan Li  1 , Yiyi Wang  1 , Zhengchen Guo  1 , Xinyu Zhu  1
Affiliations

Efficacy of Freeze-Dried Amnion Grafts on Cytokines in Uterine Exudates Following Hysteroscopic Adhesiolysis of Severe Intrauterine Adhesions

Sha Wang et al. Int J Gen Med. .

Abstract

Background: Intrauterine adhesions (IUAs) are a benign uterine disorder that results in intrauterine adhesions and scarring. This study was conducted to assess the effects of freeze-dried amnion grafts on the concentrations of adhesion-related cytokines in uterine exudates following hysteroscopic adhesiolysis of IUAs.

Materials and methods: This study was a prospective randomized controlled trial. Thirty patients who underwent hysteroscopic adhesiolysis for severe IUAs were enrolled. They were randomly divided into a study group (with freeze-dried amnion graft treatment after surgery, N = 15) and a control group (without a graft, N = 15). After complete separation of adhesions, a Foley balloon containing a freeze-dried amnion graft was inserted into the uterine cavity in the study group, while a Foley balloon with no graft was placed in the control group. Enzyme-linked immunosorbent assays were performed to test adhesion-related cytokine concentrations in uterine exudates, including IL-1β, TNF-α, and VEGF, at different time intervals after surgery. Second-look hysteroscopy was conducted three months after the surgery. On the basis of the American Fertility Society (AFS) scoring system, the level of adhesions was evaluated during hysteroscopy.

Results: The postoperative volume of the uterine exudates in the study group was significantly lower than that of the control group (P < 0.05). The adhesion-related cytokine concentrations of TNF-α, VEGF, and IL-1β significantly increased after surgery in both groups. Their concentrations were significantly lower in the study group than in the control group (P < 0.05). Moreover, IL-1β exhibited a long-lasting effect in the study group. AFS scores and readhesion rates were significantly lower in the study group than in the control group after hysteroscopic adhesiolysis of severe IUAs.

Conclusion: The application of freeze-dried amnion grafts is beneficial to the postoperative recovery of patients with severe IUAs and may reduce the readhesion rate after hysteroscopic adhesiolysis by lowering adhesion-related cytokines, including TNF-α, VEGF, and IL-1β.

Keywords: freeze-dried amnion graft; interleukin-1 beta; intrauterine adhesions; tumour necrosis factor-α; vascular endothelial growth factor.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Processing flow of freeze-dried amnion grafts.
Figure 2
Figure 2
Changes in the volume of the uterine exudate with time. The volume of daily exudate and the total volume were compared. ***P<0.001.
Figure 3
Figure 3
Changes in TNF-α in the uterine exudate with time. The concentration at each time point between the study and control groups was compared, as was the concentration between the peak and the 7th day after the operation.
Figure 4
Figure 4
Changes in VEGF in the uterine exudate with time. The concentration at each time point between the study and control groups was compared, as was the concentration between the peak and the 7th day after the operation.
Figure 5
Figure 5
Changes in IL-1β in the uterine exudate with time. The concentration at each time point between the study and control groups was compared.
Figure 6
Figure 6
Outcomes of second-look hysteroscopy. (A) Pre- and postoperative AFS scores between the two groups. (B) Postoperative readhesion rates between the two groups. *P<0.05, **P<0.01.
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