Aims

To explore the effect of intravenous tranexamic acid (IV-TXA) on inflammation and immune response following primary total knee arthroplasty (TKA).

Methods

Primary TKA patients (n = 125) were randomized into the following four groups: group A to receive placebo; group B to receive a single dose of 20 mg kg⁻¹ IV-TXA and 20 mg of intravenous dexamethasone (IV-DXM); group C to receive six doses of IV-TXA (total dosage > 6 g); and group D to receive six doses of IV-TXA combined with three doses of IV-DXM (total dosage = 40 mg). The primary outcomes were C-reactive protein (CRP) and interleukin (IL)-6 levels and the secondary outcomes were complement C3 and C4 and T-cell subset levels, which were measured preoperatively and at 24 h, 48 h, 72 h, and 2 weeks postoperatively.

Results

The postoperative peak CRP and IL-6 levels in group C (93.7 ± 22.2 mg L⁻¹, 108.8 ± 41.7 pg mL⁻¹) were lower compared with those in group A (134.7 ± 28.8 mg L⁻¹, P < 0.01; 161.6 ± 64.4 pg mL⁻¹, P < 0.01). Groups B and D exhibited significantly lower CRP and IL-6 levels compared with groups A and C at 24 h, 48 h, and 72 h postoperatively (P < 0.05 for all). In group C, complement C3 and C4 levels were higher compared with those in group A at 48 h (0.967 ± 0.127 g L⁻¹ vs. 0.792 ± 0.100 g L⁻¹, P < 0.01; 0.221 ± 0.046 g L⁻¹ vs. 0.167 ± 0.028 g L⁻¹, P < 0.01) and 72 h (1.050 ± 0.181 g L⁻¹ vs. 0.860 ± 0.126 g L⁻¹, P = 0.01; 0.240 ± 0.052 g L⁻¹ vs. 0.182 ± 0.036 g L⁻¹, P < 0.01) postoperatively and CD3 and CD4 subset levels were higher compared with those in group B at 24 h postoperatively (66.78 ± 9.29% vs. 56.10 ± 12.47%, P < 0.05; 36.69 ± 5.78% vs. 28.39 ± 8.89%, P < 0.05).

Conclusion

Six doses of IV-TXA could attenuate the inflammatory effect, modulate the immune response, and reduce immunosuppression caused by DXM in patients after TKA.

中文翻译：

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氨甲环酸在初次全膝关节置换术中减轻炎症反应并调节免疫反应：一项随机，安慰剂对照的先导试验。

目的

探讨静脉内氨甲环酸（IV-TXA）对原发全膝关节置换术（TKA）后炎症和免疫反应的影响。

方法

原发性TKA患者（n  = 125）随机分为以下四组：A组接受安慰剂； A组接受安慰剂。B组接受单剂20 mg kg ^-1 IV-TXA和20 mg静脉地塞米松（IV-DXM）；C组接受六剂IV-TXA（总剂量> 6 g）；D组接受六剂IV-TXA和三剂IV-DXM（总剂量= 40 mg）。主要结局指标为C反应蛋白（CRP）和白介素（IL）-6水平，次要结局指标为补体C3，C4和T细胞亚群水平，分别在术前，24 h，48 h，72 h，术后2周。

结果

术后峰CRP和IL-6在组C水平（93.7±22.2毫克的L ^-1，108.8±41.7 PG毫升^-1）与那些在A组（134.7±28.8毫克的L下相比^-1，P  <0.01; 161.6±64.4 pg / mL ^-1，P  <0.01）。与A，C组相比，B，D组术后24、48、72h的CRP和IL-6水平明显降低（P均 <0.05）。C组在48小时时的补体C3和C4水平高于A组（0.967±0.127 g L ^-1 vs.0.792±0.100 g L ^-1，P  <0.01; 0.221±0.046 g L ^-1 vs. 。0.167±0.028克L ^-1，P  <0.01）和72小时（1.050±0.181 g L ^-1与0.860±0.126 g L ^-1，P  = 0.01; 0.240±0.052 g L ^-1与0.182±0.036 g L ^-1，P  <0.01 ），术后24h CD3和CD4亚群水平高于B组（66.78±9.29％vs.56.10±12.47％，P  <0.05; 36.69±5.78％vs.28.39±8.89％，P  <0.05 ）。

结论

六剂IV-TXA可以减轻TKA术后患者DXM引起的炎症反应，调节免疫反应并降低免疫抑制。