Study on the Efficacy and Preliminary Mechanism of Intrauterine Administration of G-CSF in Preventing Recurrence of Ad-hesions in Moderate to Severe Intrauterine Adhesions Patients After TCRA

WANG Li; WANG Xiaoli; ZHANG Jialin; LI Danyang; DING Shuwen; LI Su; ZHANG Hongjuan

doi:10.13730/j.issn.2097-2148.2025.07.005

Abstract：Objective To study the effect of intrauterine infusion of granulocyte colony-stimulating factor(G-CSF)on preventing recurrence of intrauterine adhesions(IUA)in moderate and severe IUA patients after transcervical resection of adhesion(TCRA),and to explore its mechanism.Methods A total of 90 patients with moderate to severe IUA were selected in the author's hospital from January 2022 to March 2024 and were randomly divided into G-CSF intrauterine ad-ministration group,normal saline intrauterine administration group and control group with 30 patients in each.All the moderate to severe IUA patients underwent TCRA,and Foley balloon was placed in the uterine cavity after,and the pa-tients were given estrogen-progesterone artificial cycle treatment.Patients with the moderate to severe IUA in G-CSF in-trauterine administration group were given intrauterine administration of G-CSF after surgery;the patients with the mod-erate to severe IUA in normal saline intrauterine administration group was given intrauterine administration of normal sa-line after surgery;the patients with the moderate to severe IUA in control group did not receive intrauterine administration after surgery.The recurrence rate of IUA,American fertility society(AFS)score,pictorial blood loss assessment chart(PBAC)score,endometrial thick-ness on the conversion day of artificial cycle estrogen and progesterone of the patients with the moderate to severe IUA at the first postoperative review of hysteroscopy were com-pared among the 3 group.Uterine secretion of the moderate to severe IUA patients of G-CSF intrauterine administration group were collected before and after intrauterine administration,the expression levels of 27 kinds of immune factors were detected.Results There were statistically significant differences in the IUA recurrence rate,AFS score,PBAC score and the endometrial thickness on the conversion day of artificial cycle estrogen and progesterone of the moderate to severe IUA patients among 3 groups at the first postoperative review of hysteroscopy(all P＜0.001).Compared with the control group,the IUA recurrence rates of the moderate to severe IUA patients in the G-CSF intrauterine administration group and normal saline intrauterine administration group both decreased(all P＜0.05),and the G-CSF intrauterine administra-tion group was lower than normal saline intrauterine administration group(P＜0.05).Compared with the control group,the AFS score of the moderate to severe IUA patients in the G-CSF intrauterine administration group decreased(P＜0.05).Compared with the control group and normal saline intrauterine administration group,the PBAC score,the endo-metrial thickness on the conversion day of artificial cycle estrogen and progesterone of the moderate to severe IUA patients in G-CSF intrauterine administration group both increased(all P＜0.05).In 27 immune factors,platelet-derived growth factor BB(PDGF-BB),interleukin 13(IL-13),IL-7,IL-12,IL-1β of the moderate to severe IUA patients were up-regula-ted in G-CSF intrauterine administration group(all P＜0.05).Conclusion Intrauterine administration of G-CSF may re-duce the short-term IUA recurrence rate,reduce the degree of IUA,increase endometrial thickness and improve menstru-al volume after TCRA of moderate to severe IUA by regulating the intrauterine immune microenvironment.