目的 探析血清缺血修饰蛋白（ischemia-modified albumin， IMA）、可溶性生长刺激表达基因2蛋白（soluble growth stimulation expressed gene 2 protein，sST2）、载脂蛋白B（apolipoprotein B，ApoB）/载脂蛋白A1（apolipoprotein A1，ApoA1）与急性ST段抬高型心肌梗死（acute ST-segment elevation myocardial infarction，STEMI）患者经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）术后心电图ST段回落不良的关系。 方法 选取安徽医科大学第二附属医院2022年9月至2025年9月急诊内科收治行急诊PCI治疗的102例STEMI患者，按术后心电图ST段回落率分为回落不良组（ST段回落率< 50%，n = 31）与回落良好组（ST段回落率≥ 50%，n = 71），比较两组PCI术前、术后24 h血清IMA、sST2、ApoB/ApoA1水平，并收集两组人口学资料、病史资料、PCI治疗相关资料等，筛选STEMI术后ST段回落不良的影响因素，分析术前血清IMA、sST2、ApoB/ApoA1预测ST段回落不良的价值。 结果 102例患者术后2 h心电图示回落不良31例（30.39%），回落良好71例（69.61%），回落不良组发病至入院时间＞6 h占比、冠脉左前降支梗死占比、Killip分级≥Ⅱ级占比高于回落良好组，TIMI血流Ⅲ级占比低于回落良好组（P < 0.05）；较同组术前，术后24 h两组血清IMA、sST2、ApoB/ApoA1均降低（P < 0.05），回落不良组术前、术后24 h血清IMA、sST2、ApoB/ApoA1均高于回落良好组（P < 0.05）；术前血清IMA预测STEMI患者PCI术后ST段回落不良的曲线下面积、敏感度、特异度分别为0.818、80.65%、73.24%；sST2为0.778、64.52%、95.77%；ApoB/ApoA1为0.866、70.98%、90.14%；联合预测为0.931、77.42%、98.59%，其中联合预测效能最高（P < 0.05）；冠脉左前降支梗死（OR = 2.962、术前IMA（OR = 2.354）、术前sST2（OR = 2.517）、术前ApoB/ApoA1（OR = 2.863）是影响STEMI患者PCI术后ST段回落的危险因素（P < 0.05）；构建多因素logistic回归模型，logit（P） = -2.568 + 0.245 × 发病至入院时间（h） + 1.086 × 冠脉左前降支梗死 + 0.702 × Killip分级 + 0.935 × TIMI血流分级 + 0.856 × 术前IMA + 0.923 × 术前sST2 + 1.052 × 术前ApoB/ApoA1，该模型预测STEMI患者PCI术后ST段回落不良的发生的曲线下面积为0.956（95%CI：0.897 ~ 0.987），敏感度87.10%，特异度92.96%，Z = 22.366，P < 0.001，模型拟合优度检验χ²=5.971，P > 0.05，模型校准度良好；DCA曲线示，阈值概率在6% ~ 92%时以模型为参考可获得较高的临床效益。 结论 冠脉左前降支梗死及术前高IMA、sST2、ApoB/ApoA1比值均与STEMI患者PCI术后ST段回落不良有关，联合模型预测ST段回落不良可行性较高。

Objective To explore the relationship between serum ischemia-modified albumin （IMA）， soluble growth stimulation expressed gene 2 protein （sST2）， apolipoprotein B （ApoB）/ApoA1 and poor ST segment regression in electrocardiogram after percutaneous coronary intervention （PCI） in patients with acute ST-segment elevation myocardial infarction （STEMI）. Methods A total of 102 STEMI patients who received PCI treatment in the emergency department of the Second Affiliated Hospital of Anhui Medical University between September 2022 and September 2025 were selected. These patients were then divided into the poor regression group （with an ST-segment regression rate < 50%， n = 31） and the good regression group （with an ST-segment regression rate ≥50%， n = 71） based on the ST-segment regression rate of the postoperative electrocardiogram. The levels of serum IMA， sST2， and ApoB/ApoA1 were compared between the two groups before PCI and 2 hours after PCI. Demographic data， medical history data， and PCI-treatment-related data of the two groups were collected to screen for the influencing factors of poor ST-segment regression after STEMI. The predictive value of preoperative serum IMA， sST2， and ApoB/ApoA1 for poor ST-segment regression was analyzed. Results Among the 102 patients， 31 （30.39%） exhibited poor electrocardiogram regression 2 hours after the operation， and 71 （69.61%） showed good regression. The percentages of patients with a time from onset to admission > 6 hours， left anterior descending coronary artery infarction， and Killip grade ≥ Ⅱ were higher in the poor-regression group， whereas the percentage of TIMI blood flow grade 3 was lower （P < 0.05）. When comparing the same group before and 2 hours after the operation， serum IMA， sST2， and ApoB/ApoA1 levels decreased in both groups （P < 0.05）. The levels of serum IMA， sST2， and ApoB/ApoA1 in the poor-regression group before and 2 hours after the operation were higher （P < 0.05）. The area under the curve， sensitivity， and specificity of preoperative serum IMA for predicting poor ST-segment regression in STEMI patients after PCI were 0.818， 80.65%， and 73.24%， respectively； those of sST2 were 0.778， 64.52%， and 95.77%， respectively； those of ApoB/ApoA1 were 0.866， 70.98%， and 90.14%， respectively； and those of the combined prediction were 0.931， 77.42%， and 98.59%， respectively. Among them， the combined prediction had the highest efficacy （P < 0.05）. Left anterior descending coronary artery infarction （OR = 2.962）， preoperative IMA （OR = 2.354）， preoperative sST2 （OR = 2.517）， and preoperative ApoB/ApoA1 （OR = 2.863） were risk factors influencing ST-segment regression after PCI in STEMI patients （P < 0.05）. A multi-factor logistic regression model was constructed： logit（P） = -2.568 + 0.245 × Time from Onset to Admission （h）+1.086 × Infarction of the Left Anterior Descending Coronary Artery + 0.702 × Killip Classification + 0.935 × TIMI Flow Grade + 0.856 × Preoperative IMA + 0.923 × Preoperative sST2 + 1.052 × Preoperative ApoB/ApoA1. The area under the curve of this model for predicting poor ST-segment resolution after PCI in STEMI patients was 0.956 （95% CI： 0.897 - 0.987）， with a sensitivity of 87.10% and a specificity of 92.96%， Z = 22.366， P < 0.001. The goodness-of-fit test of the model yielded a χ² value of 5.971， with P > 0.05， which indicates good calibration of the model. The DCA curve showed that when the threshold probability was between 6% and 92%， using the model as a reference could achieve high clinical benefits. Conclusions Infarction of the left anterior descending coronary artery， preoperative high ratios of IMA， sST2， and ApoB/ApoA1 are all associated with poor ST-segment regression after PCI in STEMI patients. Moreover， the combined model shows relatively high feasibility in predicting the occurrence of adverse events related to ST-segment regression.