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目的:探讨胎儿心脏定量分析(fetal HQ)技术在评价双胎输血综合征(TTTS)胎儿经胎儿镜下激光凝固术(FLP)治疗前后心室收缩功能中的应用价值。方法:前瞻性选取2023年1－11月在郑州大学第三附属医院进行FLP治疗并在医院分娩的TTTS孕妇30例，其中供血儿组30胎，受血儿组30胎，对照组为同期同孕周34例(68胎)无并发症的单绒毛膜双羊膜囊(MCDA)双胎。应用fetal HQ技术获取所有胎儿心功能参数，比较供血儿及受血儿FLP术前，术后1 d、1周及1个月心功能参数变化。分析Quintero分期与心室整体应变(GS)、面积变化率(FAC)参数之间的相关性，进行观察者间及观察者内重复性检验。结果:①FLP术前，供血儿组左心室短轴缩短率(FS)10～24和右心室FS10～11小于对照组(均 P<0.05)；受血儿组CVPS评分及左心室GS、FAC、FS10～24和右心室GS、FAC、FS1～24小于对照组(均 P<0.05)。供血儿组Quintero分期与右心室GS呈中度正相关，与右心室FAC呈中度负相关( rs＝0.535、－0.515； P＝0.004、0.006)；而受血儿组Quintero分期与左、右心室GS和FAC之间无相关性(均 P>0.05)。②FLP术后，供血儿组术后1 d左心室收缩功能与对照组相比差异无统计学意义( P>0.05)；术后1周左心室收缩功能下降，其中左心室FS16～24小于对照组，术后1个月左心室FS21～24仍小于对照组( P<0.05)。供血儿组术后1 d右心室收缩功能降低，右心室GS、FAC及FS6～24小于对照组(均 P<0.05)；但是术后1周右心室GS、FAC及24节段FS与对照组相比差异无统计学意义(均 P>0.05)。③FLP术后，受血儿FLP术后左心室及右心室收缩功能恢复，以右心室为著。术后1个月仅左心室FS12～16小于对照组( P<0.05)，而左、右心室GS、FAC及右心室FS1～24与对照组相比差异无统计学意义(均 P>0.05)。④左心室及右心室收缩功能参数观察者间和观察者内ICC均>0.75，一致性良好( P<0.05)。 结论:Fetal HQ技术可敏感检测TTTS胎儿心脏收缩功能变化，FLP治疗前供血儿和受血儿心脏收缩功能均存在不同程度下降，治疗后两胎儿左、右心室功能均有不同程度改善且两胎儿的恢复规律不同。

Objective:To evaluate the changes of ventricular function in the twin-to-twin transfusion syndrome (TTTS) fetuses before and after fetoscopy laser photocoagulation (FLP) by fetal heart qualifiction (fetal HQ) technology.Methods:A total of 30 TTTS pregnant women who underwent FLP and delivered in the Third Affiliated Hospital of Zhengzhou University from January 2023 to November 2023 were prospectively selected as the TTTS group, including 30 donor fetuses and 30 recipient fetuses. The control group included 34 normal monochorionic diamniotic (MCDA) twins (68 fetuses) at the same gestational age. The changes of cardiac function of donor and recipient fetuses before and one day, one week and one month after FLP treatment were investigated by fetal HQ. The correlations between stage and global strain(GS) and fractional area change(FAC) of ventricle were analyzed. The inter-observer and intera-observer repeatability tests were performed.Results:①Before FLP treatment, fractional shortening(FS)10-24 of left ventricle and FS10-11 of right ventricle in donor group were lower than the control group (all P<0.05).GS, FAC, FS10-24 of left ventricle and GS, FAC, FS1-24 of right ventricle in recipient group were lower than the control group (all P<0.05). In the donor group, Quintero stage was moderately positively correlated with GS of right ventricle and moderately negatively correlated with FAC of right ventricle ( rs=0.535, -0.515; P=0.004, 0.006). But there were no correlation between Quintero stage and GS and FAC of left and right ventricle in recipient group (all P>0.05). ②After FLP treatment, the left ventricular systolic function of the donor group recovered to the normal level one day after operation ( P>0.05). But the FS16-24 of left ventricle were lower than the control group one week after operation, and the FS21-24 of left ventricle were still lower than the control group one month after operation(all P<0.05). One day after operation, the systolic function of the right ventricle in the donor group decreased, and GS, FAC and FS6-24 of the right ventricle were lower than the control group (all P<0.05). However, the right ventricular systolic function recovered to the normal level one week after operation ( P>0.05). ③After FLP, the systolic function of left ventricle and right ventricle recovered in recipient group, especially for right ventricle. One month after operation, only FS12-16 of left ventricle were lower than the control group ( P<0.05). But GS and FAC of left and right ventricle and 24 segments FS of right ventricle recovered to the control level (all P>0.05). ④The ICC of left and right ventricular parameters were greater than 0.75, indicating good repeatability ( P<0.05). Conclusions:Fetal HQ technology can sensitively evaluate fetal heart function in TTTS fetuses with good repeatability. Before FLP, the ventricular function of donor and recipient fetuses are affected to varying degrees.After FLP, the left and right ventricular function of the donor and recipient fetuses are improved to varying degrees and have different recovery rules.