中文摘要：

目的 探讨电针结合重复经颅磁刺激（rTMS）对局灶性脑缺血大鼠蛋白激酶A-环磷腺苷反应元件结合蛋白（PKA-CREB）信号转导通路的影响及其治疗缺血性脑损伤的机制.方法 取雄性Wistar大鼠75只,采用线栓法制备大鼠大脑中动脉闭塞模型,分为正常组、模型组、电针组、rTMS组和电针＋rTMS组,每组大鼠15只,通过蛋白印迹法检测正常组入组后及其它各组脑缺血后第7,14,28天3个时间点大鼠海马胞核内蛋白激酶A（PKA）、磷酸化环磷腺苷反应元件结合蛋白（pCREB）表达的变化,并观测其神经功能评分.结果 脑缺血后不同时间点缺血侧海马PKA及pCREB灰度值比较,模型组在造模后第7天时高于正常组,造模后第28天时低于正常组,差异均有统计学意义（P＜0.05）,造模后第14天时与正常组相比差异无统计学意义（P＞0.05）;电针组、rTMS组和电针＋rTMS组3个时间点均高于模型组,造模后第7,14天时高于正常组,差异具有统计学意义（P＜0.05）,造模后第28天时与正常组相比差异无统计学意义（P＞0.05）,其中,电针＋rTMS组第7,14天时高于电针组、rTMS组,差异有统计学意义（P＜0.05）,电针组和rTMS组各时间点差异均无统计学意义（P＞0.05）.电针组、rTMS组和电针＋rTMS组各时间点神经功能评分均较模型组改善（P＜0.01）,其中以电针＋rTMS组神经功能评分改善最为明显.结论 电针结合rTMS对脑卒中后神经功能的恢复具有显著的促进作用,蛋白激酶A-环磷腺苷反应元件结合蛋白信号转导通路蛋白的表达增强可能是其治疗缺血性脑卒中的机制之一.

英文摘要：

Objective To investigate the effects of electro-acupuncture （EA） combined with repetitive transcranial magnetic stimulation （rTMS） on protein kinase A-cyclic adenosine monophosphate response element binding protein （PKA-CREB） signal transduction system after focal cerebral ischemia in adult rats and to explore the mechanism of EA combined with rTMS in treating ischemic brain injury.Methods The animal model of transient focal ischemia was made by artificial middle cerebral artery occlusion. Seventy-five Wistar rats were randomly divided into normal group, model group, EA group, rTMS group and EA＋rTMS group. The expressions of PKA and pCREB in hippocampus were detected and the neurologic impairment rating was observed at the 7th, 14th and 28th days, respectively, after infarction.Results The average gray densities of PKA and pCREB expressions in hippocampus after focal cerebral ischemia in model group were higher at the 7th d, lower at the 28th d than that in normal group （P〈0.05）;higher in EA group, rTMS group, EA＋rTMS group than that in model group at all time points （P〈0.05）, higher in EA＋rTMS group than that in EA group and rTMS group at 7th and 14th d（P〈0.05）, and there was no difference between EA group and rTMS group（P〉0.05）.The improvement of neural motor function was obvious in EA group, rTMS group and EA＋rTMS group compared with model group （P〈0.01）, especially in EA＋rTMS group.Conclusions EA combined with rTMS can promote the functional recovery after cerebral ischemia,enhance the expression of PKA-CREB signal transduction system in hippocampus after focal cerebral ischemia, which might be one of the important mechanisms of EA combined with rTMS in treating ischemia brain injury.