血清IMA、sST2、ApoB/ApoA1与急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗术后心电图ST段回落不良的关系

doi:10.3969/j.issn.1006-5725.2026.06.022

Abstract

Abstract:

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.

Key words: percutaneous coronary intervention, acute ST-segment elevation myocardial infarction, ischemia-modified albumin, soluble growth stimulation expressed gene 2 protein, apolipoprotein, ST segment regression

CLC Number:

Qian TANG,Zeyan LIU,Jinglin CHENG. The relationship of serum IMA， sST2， ApoB/ApoA1 with poor ST segment regression on electrocardiogram after PCI in STEMI patients[J]. The Journal of Practical Medicine, 2026, 42(6): 1078-1087.

Figures/Tables 9

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References 26

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变量	回落不良组（n = 31）	回落良好组（n = 71）	χ² /t值	P值
男性	20（64.52）	42（59.15）	0.260	0.610
年龄分层			0.749	0.387
< 60岁	7（22.58）	22（30.99）
≥ 60岁	24（77.42）	49（69.01）
发病至入院时间			9.269	0.002
≤ 6 h	14（45.16）	54（76.06）
> 6 h	17（54.84）	17（23.94）
BMI（x ± s）/（kg/m²）	23.26 ± 2.63	23.48 ± 1.93	0.472	0.638
吸烟	19（61.29）	39（54.93）	0.356	0.551
饮酒	13（41.94）	26（36.62）	0.258	0.611
糖尿病	9（29.03）	16（22.54）	0.492	0.483
高血压	15（48.39）	36（50.70）	0.046	0.830
高脂血症	10（32.26）	19（26.76）	0.321	0.571
冠脉左前降支梗死	23（74.19）	34（47.89）	6.057	0.014
梗死部位			1.665	0.435
前壁	20（64.52）	36（50.70）
下壁	7（22.58）	22（30.99）
其他	4（12.90）	13（18.31）
病变血管支数			1.707	0.191
单支	14（45.16）	42（59.15）
双支及以上	17（54.84）	29（40.85）
支架直径（x ± s）/mm	3.31 ± 0.42	3.17 ± 0.35	1.746	0.084
置入支架数目（x ± s）/枚	1.48 ± 0.36	1.44 ± 0.30	0.582	0.561
Killip分级			4.716	0.030
< Ⅱ级	12（38.71）	44（61.97）
≥ Ⅱ级	19（61.29）	27（38.03）
TIMI血流Ⅲ级	19（61.29）	60（84.51）	6.660	0.010

组别	IMA（IU/mL）		t值	P值	sST2（pg/mL）		t值	P值	ApoB/ApoA1		t值	P值
组别	术前	术后24 h	t值	P值	术前	术后24 h	t值	P值	术前	术后24 h	t值	P值
回落不良组（n = 31）	186.78 ± 30.61	130.79 ± 15.54	13.510	< 0.001	110.78 ± 30.52	86.25 ± 15.79	8.759	< 0.001	1.75 ± 0.34	1.42 ± 0.41	4.900	< 0.001
回落良好组（n = 71）	145.75 ± 40.96	86.52 ± 20.89	16.138	< 0.001	82.14 ± 15.71	50.63 ± 12.75	18.658	< 0.001	1.32 ± 0.27	0.81 ± 0.22	17.540	< 0.001
t值	5.001	10.578			6.256	12.049			6.823	9.759
P值	< 0.001	< 0.001			< 0.001	< 0.001			< 0.001	< 0.001

项目	AUC	截断值	Youden index	SE	95%CI	P值	敏感度/%	特异度/%
IMA/（IU/mL）	0.818	160.57	0.539	0.046	0.730 ~ 0.888	< 0.001	80.65	73.24
sST2/（pg/mL）	0.778	101.85	0.603	0.061	0.685 ~ 0.855	< 0.001	64.52	95.77
ApoB/ApoA1	0.866	1.63	0.611	0.040	0.784 ~ 0.925	< 0.001	70.97	90.14
联合	0.931	-	0.760	0.035	0.864 ~ 0.972	< 0.001	77.42	98.59

自变量	赋值
发病至入院时间	≤ 6 h = 0，> 6 h = 1
冠脉左前降支梗死	否 = 0，是 = 1
Killip分级	< Ⅱ级 = 0，≥ Ⅱ级 = 1
TIMI血流Ⅲ级	否 = 0，是 = 1
术前IMA	≤ 160.57 IU/mL = 0，> 160.57 IU/mL = 1
术前sST2	≤ 101.85 pg/mL = 0，> 101.85 pg/mL = 1
术前ApoB/ApoA1	≤ 1.63 = 0，> 1.63 = 1

自变量	β	SE	Wald χ²	P值	OR值	95%CI
常数	-2.568	0.825	9.689	0.002	-	-
发病至入院时间	0.245	0.208	1.387	0.240	1.278	0.850 ~ 1.921
冠脉左前降支梗死	1.086	0.312	12.116	< 0.001	2.962	1.607 ~ 5.460
Killip分级	0.702	0.586	1.435	0.232	2.018	0.640 ~ 6.363
TIMI血流Ⅲ级	0.935	0.598	2.445	0.119	2.547	0.789 ~ 8.224
术前IMA	0.856	0.287	8.896	0.003	2.354	1.341 ~ 4.131
术前sST2	0.923	0.305	9.158	0.003	2.517	1.384 ~ 4.576
术前ApoB/ApoA1	1.052	0.318	10.944	0.001	2.863	1.535 ~ 5.340

The relationship of serum IMA， sST2， ApoB/ApoA1 with poor ST segment regression on electrocardiogram after PCI in STEMI patients

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自变量	VIF值	容忍度	共线性判断
发病至入院时间	1.215	0.823	无明显共线性
冠脉左前降支梗死	1.326	0.754	无明显共线性
Killip分级	1.432	0.698	无明显共线性
TIMI血流Ⅲ级	1.298	0.771	无明显共线性
术前IMA	1.495	0.669	无明显共线性
术前sST2	1.472	0.679	无明显共线性
术前ApoB/ApoA1	1.386	0.721	无明显共线性
平均值	1.375	0.727	整体无共线性

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