重复经颅磁刺激叠加运动训练对脊髓损伤大鼠运动功能和神经元可塑性的影响  

Effects of combined rTMS and exercise training on locomotor function and neuronal plasticity in rats with spinal cord injury

作　　者：殷睿安 王双燕 王培[1] 许光旭 王红星[4] YIN Ruian;WANG Shuangyan;WANG Pei

机构地区：[1]南京医科大学,南京210029 [2]南京医科大学附属江苏盛泽医院 [3]南京医科大学第一附属医院 [4]东南大学附属中大医院

出　　处：《中国康复医学杂志》2021年第7期774-778,792,共6页Chinese Journal of Rehabilitation Medicine

基　　金：苏州市临床医学专家团队引进项目(SZYJTD201725);国家自然科学基金青年科学基金项目(81000853);江苏高校优势学科建设工程项目(JX10231801);江苏省卫生健康委员会江苏省青年医学人才项目(QNRC2016216);中央高校基本科研业务费专项资金项目(2242020K40172)。

摘　　要：目的:观察重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)叠加运动训练对不完全性脊髓损伤(spinal cord injury,SCI)大鼠运动恢复和神经元可塑性的影响。方法:60只大鼠随机分为假手术组(Sham组)、脊髓损伤对照组(SCI组)、单纯运动训练组(SCI-ET组)、先运动后rTMS组(SCI-ET+rTMS组)、先rTMS后运动组(SCI-rTMS+ET组)。Sham组仅进行T9水平椎板切除术,无SCI;SCI组建立脊髓挫伤模型,不进行训练干预;在SCI后,SCI-ET组仅进行跑台运动训练,SCI-ET+rTMS组每次在运动训练结束后立即进行rTMS,SCI-rTMS+ET组则在运动训练前进行rTMS。术前及术后采用BBB、神经电生理评价运动及神经元功能,并用Western Blot法检测腰髓(L2-4)处脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)及synapsin I的蛋白表达。结果:8周干预后,(1)与SCI组相比,SCI-ET+rTMS组(P<0.05)和SCI-rTMS+ET组(P<0.01)的BBB评分升高,F波波幅减小(P<0.05),腰髓BDNF蛋白表达增高(P<0.01),但仅SCI-rTMS+ET组synapsin I表达增高(P<0.01);(2)与SCIET组相比,SCI-rTMS+ET组BBB评分和BDNF表达显著升高(P<0.05)。结论:rTMS叠加运动训练可显著提升不完全性SCI大鼠的后肢运动功能,通过诱导促进BDNF和synapsin I表达,改善中枢运动控制及运动神经元可塑性。Objective:To investigate the effect of repetitive transcranial magnetic stimulation(rTMS)combined with exercise training on locomotion recovery and neuronal plasticity in rats with incomplete spinal cord injury(SCI).Method:Sixty rats were randomly divided into Sham operation group(Sham),spinal cord injury control group(SCI group),individual exercise training group(SCI-ET group),rTMS after exercise training group(SCI-ET+rTMS group),and rTMS before exercise training group(SCI-rTMS+ET group).In the Sham group,only T9 level laminectomy was performed without SCI.In the SCI group,spinal cord contusion model was established without treatment.After SCI,only treadmill training was performed in the SCI-ET group;rTMS was conducted immediately after treadmill training in the SCI-ET+rTMS group,while rTMS was conducted before treadmill training in the SCI-rTMS+ET group.BBB scale and neuroelectrophysiology test were performed to evaluate locomotor and neuronal function before and after the operation.After our intervention,Western Blot was used to detect the expressions of brain-derived neurotrophic factor(BDNF)and synapsin I in lumbar spinal cord(L2—4).Result:After 8-week-treatment,compared with the SCI group,BBB scores significantly enhanced in the SCIET+rTMS group(P<0.05)and SCI-rTMS+ET group(P<0.01),accompanied by decreased F wave amplitude(P<0.05)and increased BDNF protein expression(P<0.01).However,synapsin I protein increased only in the SCIrTMS+ET group(P<0.01).Specifically,BBB score and BDNF expression in the SCI-rTMS+ET group were significantly higher than those in the SCI-ET group(P<0.05).Conclusion:rTMS combined with exercise training can enhance the hind limb locomotion of incomplete SCI rats,improve motor control of central nerve and motor neuron plasticity by promoting BDNF and synapsin I expression.

关 键 词：脊髓损伤 运动训练 重复经颅磁刺激 运动神经元 脑源性神经营养因子 synapsin I 

分 类 号：R651.2[医药卫生—外科学] R493[医药卫生—临床医学]