| 【Background and Objectives】Moderate to severe intrauterine adhesion(IUA)has great adverse impacts on the health of women in childbearing period.Currently,the main treatment is hysteroscopic adhesiolysis.However,the higher re-adhesion rate and the lower pregnancy rate after surgery bring great challenges to clinical work.Therefore,necessary adjuvant treatments are often taken after intrauterine adhesiolysis to prevent adhesions recurrence and improve reproductive outcomes.Intrauterine perfusion of platelet-rich plasma(PRP)is one of the adjuvant treatments,which has attracted increasing attention in the endometrium repair.Whether it can effectively lower the postoperative adhesion recurrence rate,improve the menstrual volume,and increase the pregnancy rate in patients with moderate to severe IUA remains controversial.The purpose of present study was to reveal the therapeutic effect of intrauterine perfusion of PRP as an adjuvant treatment after hysteroscopic adhesiolysis in the comprehensive treatment of moderate to severe IUA.To provide some evidence for clinical workers to tailor the comprehensive treatment of moderate to severe IUA.【Methods】(1)Clinical data of moderate to severe IUA patients who underwent hysteroscopic adhesiolysis in Reproductive Medicine Center,Department of Obstetrics and Gynecology,Tangdu Hospital,Air Force Medical University from July 2020 to June 2021 were retrospectively collected and analyzed in the real-world.To preliminarily evaluate the efficacy of intrauterine perfusion of PRP as an adjuvant treatment of IUA,descriptive analysis was conducted.The baseline characteristic indicators,and the clinical outcome indicators such as,clinical pregnancy rate and the improvement rate of menstrual volume between the intrauterine perfusion of PRP group and the routine treatment group were compared.Univariate and multivariate logistic regression analysis were used to analyze variables that might influence the occurrence of clinical pregnancy,to explore the related factors affecting the clinical pregnancy rate after hysteroscopic adhesiolysis.Some important baseline characteristics indicators were balanced between the two groups by propensity score matching(PSM),and a descriptive analysis was performed in a population with higher homogeneity to evaluate the efficacy of PRP after PSM.In addition,the patients were stratified according to age,adhesion grades and the history of hysteroscopic surgery,to further determine the population who can get more benefits from the intrauterine perfusion of PRP after surgery.(2)A real-world prospective cohort study was conducted to analyze the clinical data of moderate to severe IUA patients who underwent hysteroscopic adhesiolysis at the Reproductive Medicine Center,Department of Obstetrics and Gynecology,Tangdu Hospital,Air Force Medical University from July 2021 to September 2022.The efficacy of intrauterine perfusion of PRP as the adjuvant treatment of IUA was evaluated primarily.In comparison of the improvement rate of menstrual volume and the postoperative American Fertility Society(AFS)score between the intrauterine perfusion of PRP group and the routine treatment group after intrauterine adhesiolysis.Univariate and multivariate logistic regression analysis were used to explore the clinical factors that might affect the improvement rate of menstrual volume after surgery.Descriptive analysis was performed in a more homogenous population after PSM,to further evaluate the efficacy of intrauterine perfusion of PRP.In addition,to identify the target patients who could benefit more from this adjuvant treatment,stratified analysis was conducted according to adhesion grades,age,and history of hysteroscopic surgery.【Results】(1)The first part of this study was a retrospective cohort study.Based on the inclusion and exclusion indexes,133 patients were finally recruited and divided into the intrauterine perfusion of PRP group(n = 48)and the routine treatment group(n = 85).Chi-square test showed that the clinical pregnancy rate in the intrauterine perfusion of PRP group was higher than that in the routine treatment group(41.7% vs.28.2%,P = 0.114).The improvement rate of menstrual volume in the intrauterine perfusion of PRP group was slightly lower than that in the routine treatment group(68.8% vs.70.6%,P = 0.824).The results of univariate logistic regression analysis showed that age [Odds ratio(OR)= 0.37,95% CI = 0.17-0.80,P = 0.012] and adhesion grades(OR = 0.35,95% CI = 0.15-0.80,P =0.013)were significantly associated with the occurrence of clinical pregnancy in patients with moderate to severe IUA.Multivariate logistic regression analysis showed that in the crude model,intrauterine perfusion of PRP could not significantly improve the clinical pregnancy rate(OR = 1.82,95% CI = 0.86-3.82,P = 0.116).However,in the adjusted model,the result showed that intrauterine perfusion of PRP after surgery can significantly improve the clinical pregnancy rate(adjusted OR = 3.00,95% CI = 1.22-7.38,P = 0.017).After PSM,39 patients were matched in both groups.The clinical pregnancy rate in the intrauterine perfusion of PRP group was significantly higher than that in the routine treatment group,the difference was statistically significant(46.2% vs.20.5%,P = 0.031).However,there was no significant difference in the improvement rate of menstrual volume between the two groups(66.7% vs.71.8%,P = 0.806).The results of stratified analysis showed that intrauterine perfusion of PRP can significantly improve the clinical pregnancy rate in patients who younger than 35 years,diagnosed with moderate IUA,or without a history of hysteroscopic surgery(OR = 3.02,95% CI = 1.16-7.90,P = 0.024),(OR = 2.73,95% CI =1.06-7.02,P = 0.037),(OR = 2.67,95% CI = 1.06-6.73,P = 0.038).(2)In the second part of this research,it was a prospective cohort study.In this cohort,161 patients were enrolled finally according to the inclusion and exclusion criteria.109 out of 161 patients in the intrauterine perfusion of PRP group and 52 patients in the routine treatment group.Chi-square test showed that the improvement rate of menstrual volume in the intrauterine perfusion of PRP group was higher than that in the routine treatment group(72.5% vs.51.9%,P = 0.010),and the difference was statistically significant.The results of univariate logistic regression analysis showed that intrauterine perfusion of PRP may significantly affect the improvement of menstrual volume in patients with moderate to severe IUA(OR = 2.44,95% CI = 1.23-4.85,P = 0.011).In multivariate logistic regression analysis,the results of the crude model showed that intrauterine perfusion of PRP could significantly improve postoperative menstrual volume(OR = 2.44,95% CI = 1.23-4.85,P= 0.011).Similarly,the result of adjusted model showed that intrauterine perfusion of PRP could significantly improve postoperative menstrual volume(adjusted OR = 2.70,95% CI= 1.21-6.01,P = 0.015).After PSM,39 patients were in both groups.The improvement rate of menstrual volume in the intrauterine perfusion of PRP group was higher than that in the routine treatment group,but the difference was not statistically significant(69.2% vs.56.4%,P = 0.349).Stratified analysis showed that intrauterine perfusion of PRP could significantly improve the menstrual volume in patients,whose age younger than 35 years old,diagnosed with moderate IUA or were not combined with the history of hysteroscopic surgery(OR =3.21,95% CI = 1.33-7.73,P = 0.009),(OR = 3.17,95% CI = 1.28-7.85,P = 0.013),(OR =2.75,95% CI = 1.16-6.51,P = 0.021).【Conclusions】Based on the results of the two parts of this study,we concluded that intrauterine perfusion of PRP as an adjuvant treatment after hysteroscopic adhesiolysis has great potential in improving the menstrual volume and increasing the clinical pregnancy rate in patients diagnosed with moderate to severe IUA. |
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