电针结合经颅磁刺激对局灶性脑缺血大鼠pCREB表达的影响

目的：探讨电针结合经颅磁刺激（rTMS）对局灶性脑缺血大鼠磷酸化环腺苷酸反应元件结合蛋白（pCREB）表达的影响及其治疗缺血性脑损伤的机制。方法：Wistar大鼠75只，随机分为A、B、C、D及E组各15只，A组为正常对照，B、C、D及E组大鼠采用线栓法制备局灶性脑缺血模型，术后A、B组不实施处理，C组进行电针治疗，D组给予rTMS治疗，E组给予电针及rTMS联合治疗。通过Western blot检测脑缺血后第7、14及28d3个不同时相大鼠海马胞核内pCREB的表达，并观测神经功能缺损程度评分的变化。结果：脑缺血后不同时相点缺血侧海马pCREB阳性表达和灰度值，B组在7d时高于A组，28d时低于A组（P〈0．05），14d时与A组比较差异无显著性意义；C、D组和E组各时相点均高于B组，7及14d时高于A组（均P〈0．05），28d时与A组比较无差异；E组7及14d时相点均高于C及D组（P〈0．05）；C与D组各时相点均无差异。各时相点神经功能缺损评分C、D组和E组均较B组下降（P〈0．01），尤以E组为明显。结论：电针结合rTMS对脑卒中后神经功能的恢复有显著的促进作用，pCREB的表达增强可能是其治疗缺血性脑卒中的机制之一。

Effects of Electro-acupuncture Combined with rTMS on pCREB Expression after Focal Cerebral Ischemia in Adult Rats

Objective： To investigate the effects of electro-acupuncture （EA） combined with repetitive transcranial magnetic stimulation （rTMS） on pCREB expression after focal cerebral ischemia in adult rats and to explore the mechanism of EA combined with rTMS in treating isehemic brain injury. Methods：The model of transient focal ischemia was made by occlusion of the middle cerebral artery. Seventy-five Wistar rats were randomly divided into normal group, model group, EA group, rTMS＇group, and EA combined with rTMS group. The neurologic impairment rating, ability of learning and memory were observed at the 7th, 14th and 28th day after infarction respectively. Meanwhile, Western blotting was used to detect the pCREB expression at the 7th, 14th and 28th day after infarction respectively. Results： The average gray density by Western blotting in hippocampus after focal cerebral ischemia in the model group was higher at the 7th day, lower at the 28th day than that in normal group （P〈0.05）, higher in EA, rTMS, and EA combined with rTMS groups than in model group at every time point and normal group at 7th and 14th day （P〈0.05）, higher in EA combined with rTMS group than that in EA, and rTMS groups at 7th and 14th day, and there was no significant difference between EA group and rTMS group. The improvement of neural motor function deficits as well as the indexes of learning and memory was more obvious in EA, rTMS, and EA combined with rTMS groups than in model group （P〈0. 01, P〈 0.05）, and the improvement was the most obvious in EA combined with rTMS group. Conclusion： EA combined with rTMS can enhance the expression of pCREB in hippocampus after focal cerebral ischemia, which might be one of the important mechanisms of EA combined with rTMS in treating ischemia brain injury.