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磷酸化环腺苷酸反应元件结合蛋白（p-CREB）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，采用线栓法制备大鼠大脑中动脉闭塞模型，随机分为正常组、模型组、电针组、rTMS组和电针结合rTMS组，通过免疫组化检测脑缺血后第7天、第14天与第28天三个不同时相大鼠海马胞核内p-CREB表达的变化，并观测其神经功能评分和学习记忆能力。结果：脑缺血后不同时相缺血侧海马p-CREB阳性表达，模型组在第7天时高于正常组，第28天时低于正常组P〈0．05．第14天时与正常组相比P〉0．05；电针组、rTMS组和电针结合rTMS组三个时相均高于模型组，第7天、第14天时高于正常组，差异具有屁著性意义（P〈0．05），第28天时与正常组相比P〉0．05，其中，电针结合rTMS组第7天、第14天时高于电针组、rTMS组P〈0．05，电针组和rTMS组各时相均无显著性差异（P〉0．05）。电针组、rTMS组和电针结合rTMS组各时相神经功能评分和电跳台实验评分均较模型组改善（P〈0．01，P〈0．05），尤以电针结合rTMS组为明显。结论：电针结合rTMS促进p—CREB的表达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 phosphorylated CAMP responsive element binding protein （p-CREB） expression after focal cerebral ischemia in adult rats and to explore the mechanism of EA combined with rTMS in treating ischemic brain injury. Method： The model of transient focal cerebral isehemia 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 expressions of p-CREB in hippocampus were detected and the neurologic impairment rating, ability of learning and memory were observed at the 7^th,14^th and 28^th d after infarction respectively. Result： The number of p-CREB-positive cells in hippocampus after focal cerebral ischemia in model group was higher at the 7^thd, lower at the 28^th d than that in nomal group （P〈0.05）; higher in EA group, rTMS group, EA combined with rTMS group than that in model group at each time point and nomal group at the 7^th and 14^th d（P〈0.05）, higher in EA combined with rTMS group than that in EA group, rTMS group at 7 and 14^th d, and there was no difference between EA group and rTMS group. The improvement of neural motor function as well as the indexes of learning and memory were much better in EA group, rTMS group, and EA combined with rTMS group compared with model group （P〈0.01, P〈0.05）,and the improvement were the most obvious in EA combined with rTMS group. Conclusion： EA combined with rTMS can enhance the expression of p-CREB in hippocampus after focal cerebral ischemia, which might be one of the important mechanisms of EA combined with rTMS in treating ischemia brain injury.