二肽基肽酶样蛋白⁃6抗体相关脑炎临床特征和预后分析
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1南京医科大学附属脑科医院老年医学科,2神经内科,江苏 南京 210029

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R742

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国家自然科学基金(81501126);江苏省卫生健康委员会面上项目(M2022065);南京市卫生健康委员会一般项目(YKK21110);南京脑科医院青年人才项目


Clinical characterization and prognostic analysis of dipeptidyl ⁃ peptidase ⁃ like protein 6 antibody⁃associated encephalitis
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1Department of Geriatrics,2Department of Neurology,Nanjing Brain Hospital Affiliated to Nanjing MedicalUniversity,Nanjing 210029 ,China

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    摘要:

    目的:分析二肽基肽酶样蛋白-6(dipeptidyl-peptidase-like protein 6,DPPX)抗体相关脑炎患者的临床特征。方法:对 2016年1月—2025年2月南京医科大学附属脑科医院就诊的5例DPPX抗体相关脑炎患者的临床特点、脑电图、磁共振成像 (magnetic resonance imaging,MRI)及预后进行回顾性研究。结果:5例均为男性,年龄14~56岁。5例患者血清DPPX抗体均为阳性,滴度1∶100~1∶10,其中1例合并血清接触蛋白关联蛋白2(contactin-associated protein-like 2,CASPR2)抗体阳性,4例脑脊液DPPX抗体阴性,1例滴度1∶1。2例患者以行为异常起病,1例以癫痫发作起病,1例以记忆力减退起病,1例合并CASPR2抗体阳性患者以多部位游走性肌阵挛起病。4例患者头颅MRI正常,1例头颅MRI提示双侧颞叶异常信号。以癫痫发作起病的患者脑电图背景重度异常合并左前颞尖波、尖慢波频发。结论:DPPX抗体相关脑炎临床表现具有异质性,早期诊断与鉴别困难,免疫治疗有效,易复发。

    Abstract:

    Objective:To analyze the clinical characteristics of patients diagnosed with dipeptidyl-peptidase-like protein 6(DPPX) antibody -associated encephalitis. Methods:A retrospective analysis was conducted on five patients with DPPX antibody -associated encephalitis admitted to the Nanjing Brain Hospital Affiliated to Nanjing Medical University between January 2016 and February 2025. Clinical characteristics,electroencephalography(EEG),magnetic resonance imaging(MRI)findings,and outcomes were reviewed. Results:All five patients were male,aged from 14 to 56 years. All patients tested positive for DPPX antibody in serum,with titers ranging from 1∶100 to 1∶10. One patient also tested positive for serum contactin-associated protein-like 2(CASPR2)antibody. Cerebrospinal fluid(CSF)DPPX antibody were negative in four patients,and positive in one patients with the titer 1∶1. Two patients presented with behavioral abnormalities,one with seizures,and one with memory impairment. The patient with concurrent anti-DPPX and anti-CASPR2 antibodies presented with multifocal migratory myoclonus. Brain MRI was normal in four patients,while one patient’s brain MRI indicated an abnormal signal in the bilateral temporal lobe. EEG of the patient with seizure onset showed heavy background abnormalities,accompanied by frequent sharp waves and sharp - slow waves in the left anterior temporal region. Conclusion:DPPX antibody -associated encephalitis is characterized by heterogeneous clinical presentations,which may complicate early diagnosis and differential diagnosis. Although immunotherapy demonstrates therapeutic efficacy,the disease remains susceptible to relapse.

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胡秀秀,苗爱亮.二肽基肽酶样蛋白⁃6抗体相关脑炎临床特征和预后分析[J].南京医科大学学报(自然科学版),2026,46(3):452-456

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  • 收稿日期:2025-09-04
  • 最后修改日期:2025-11-14
  • 录用日期:2025-11-18
  • 在线发布日期: 2026-03-12
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