Li Er-Chuang, Zhang Tian-Yi, Cai Meng-Ting, Su Sheng-Yao, Shen Chun-Hong, Lai Qi-Lun, Zhang Yin-Xi
Department of Neurology, Taikang Ningbo Hospital.
Department of Neurology, First Affiliated Hospital, School of Medicine, Zhejiang University.
Neurol Neuroimmunol Neuroinflamm. 2025 Mar;12(2):e200350. doi: 10.1212/NXI.0000000000200350. Epub 2024 Dec 18.
In dipeptidyl-peptidase-like protein 6 (DPPX) antibody-associated encephalitis, DPPX antibodies from serum and CSF target the extracellular subunit of the voltage-gated potassium channel 4.2. This targeting leads to a characteristic clinical triad comprising gastrointestinal symptoms (predominantly diarrhea), cognitive-psychiatric dysfunction, and manifestations of CNS hyperexcitability, with hyperekplexia being a more specific feature. This rare disease typically presents with a subacute or chronic course and often affects middle-aged and older individuals. Patients may have a weak association with certain hematologic malignancies, particularly lymphoma and chronic lymphocytic leukemia. Brain MRI typically shows normal findings or nonspecific white matter changes. DPPX antibody-associated encephalitis responds well to immunotherapy, and most patients ultimately present with a good prognosis. However, relapses can occur. To improve our understanding of this rare but treatable autoimmune encephalitis and avoid misdiagnosis, we conduct a systematic review and summarize the current knowledge of its clinical and paraclinical features, management, and prognosis.
在二肽基肽酶样蛋白6(DPPX)抗体相关脑炎中,血清和脑脊液中的DPPX抗体靶向电压门控钾通道4.2的细胞外亚基。这种靶向作用导致一个特征性的临床三联征,包括胃肠道症状(主要是腹泻)、认知-精神功能障碍以及中枢神经系统兴奋性增高的表现,其中惊跳反射增强是一个更具特异性的特征。这种罕见疾病通常呈亚急性或慢性病程,且常累及中年及老年个体。患者可能与某些血液系统恶性肿瘤存在微弱关联,尤其是淋巴瘤和慢性淋巴细胞白血病。脑部磁共振成像(MRI)通常显示正常结果或非特异性白质改变。DPPX抗体相关脑炎对免疫治疗反应良好,大多数患者最终预后良好。然而,可能会复发。为增进我们对这种罕见但可治疗的自身免疫性脑炎的了解并避免误诊,我们进行了一项系统综述,并总结了其临床和临床旁特征、管理及预后的当前知识。