Research progress on the interaction between dyslipidemia and gut microbiota in the pathogenesis and progression of hypertriglyceridemia-induced acute pancreatitis and its diagnostic and therapeutic strategies_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Shiyan ^1,2 , QUAN Zihan ^1,2 , REN Chaosheng ^1,2 , JIANG Wenkai ² ,  AN Yanxin ²

1. Graduate School of Xi’an Medical University, Xi’an 710000, P. R. China;
2. Department of General Surgery, The First Affiliated Hospital of Xi’an Medical University, Xi’an 710000, P. R. China;

Corresponding?author：

AN Yanxin, Email: DocAnYX@outlook.com

Keywords：

hypertriglyceridemia; acute pancreatitis; gut microbiota; gut–pancreas axis; inflammatory response; microecological modulation

DOI：

10.7507/1007-9424.202605077

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review the pathophysiological mechanisms and clinical characteristics of hypertriglyceridemia-associated acute pancreatitis, with a particular focus on the role of the gut microbiota and the gut–pancreas axis, and to summarize emerging microbiota-targeted therapeutic strategies and future research directions. Methods Relevant literature published in recent years was reviewed and analyzed. Evidence regarding epidemiological features, pathogenic mechanisms, alterations in gut microbial composition, and microbiota-based therapeutic approaches was synthesized to establish an integrated framework linking dyslipidemia, gut microbial dysbiosis, and acute pancreatitis. Results Current evidence suggests that hypertriglyceridemia contributes to the initiation and progression of acute pancreatitis through multiple mechanisms, including lipotoxic injury, inflammatory cascade activation, and microcirculatory dysfunction. Gut microbiota dysbiosis and impairment of intestinal barrier integrity are closely associated with disease severity. Microbial metabolites and immune-regulatory pathways may play important roles in disease progression. Microbiota-targeted interventions have demonstrated potential in modulating inflammation, maintaining intestinal barrier function, and restoring metabolic homeostasis; however, their clinical efficacy and safety require further validation. Conclusions The gut microbiota and the gut–pancreas axis may represent key regulatory links between hypertriglyceridemia and acute pancreatitis. Further elucidation of the underlying mechanisms and advancement of precision microbiome-based interventions may provide novel approaches for risk stratification, early intervention, and comprehensive management of hypertriglyceridemia-associated acute pancreatitis.

1.	Kiss L, F?r G, Pisipati S, et al. Mechanisms linking hypertriglyceridemia to acute pancreatitis. Acta Physiol (Oxf), 2023, 237(3): e13916. doi: 10.1111/apha.13916.
2.	Fu ZH, Zhao ZY, Liang YB, et al. Impact of metabolic syndrome components on clinical outcomes in hypertriglyceridemia-induced acute pancreatitis. World J Gastroenterol, 2024, 30(35): 3996-4010.
3.	Deng H, Peng K, Zhang L, et al. Clinical outcomes in a multicenter cohort involving 919 patients with hypertriglyceridemia-associated acute pancreatitis. Am J Gastroenterol, 2025, 120(10): 2405-2414.
4.	Song XF, Liu Y, Fei QM, et al. Potential influence of gut microbiota on the process of hypertriglyceridemia-aggravated acute pancreatitis. World J Gastroenterol, 2026, 32(1): 114479. doi: 10.3748/wjg.v32.i1.114479.
5.	Shaka H, Asotibe JC, Achebe I, et al. Higher inpatient morbidity and mortality in biliary pancreatitis compared to hypertriglyceridemia-induced pancreatitis: a nationwide retrospective study. Cureus, 2020, 12(9): e10351. doi: 10.7759/cureus.10351.
6.	Fan Z, Li J, Wu D. Hypertriglyceridemic pancreatitis: perspectives from China. Curr Opin Gastroenterol, 2025, 41(5): 348-354. doi: 10.1097/MOG.0000000000001123.
7.	Mosztbacher D, Hanák L, Farkas N, et al. Hypertriglyceridemia-induced acute pancreatitis: a prospective, multicenter, international cohort analysis of 716 acute pancreatitis cases. Pancreatology, 2020, 20(4): 608-616.
8.	Goldberg RB, Chait A. A comprehensive update on the chylomicronemia syndrome. Front Endocrinol (Lausanne), 2020, 11: 593931. doi: 10.3389/fendo.2020.593931.
9.	Corrado MJ, Kovacevic MP, Dube KM, et al. The incidence of propofol-induced hypertriglyceridemia and identification of associated risk factors. Crit Care Explor, 2020, 2(12): e0282. doi: 10.1097/CCE.0000000000000282.
10.	Pu N, Yang Q, Shi XL, et al. Gene-environment interaction between APOA5 c. 553G>T and pregnancy in hypertriglyceridemia-induced acute pancreatitis. J Clin Lipidol, 2020, 14(4): 498-506.
11.	Fei F, Boshell N, Williams LA 3rd. Predictability and efficacy of therapeutic plasma exchange for hypertriglyceridemia induced acute pancreatitis. Transfus Apher Sci, 2020, 59(2): 102699. doi: 10.1016/j.transci.2019.102699.
12.	Zádori N, Gede N, Antal J, et al. EarLy Elimination of Fatty Acids iN hypertriglyceridemia-induced acuTe pancreatitis (ELEFANT trial): protocol of an open-label, multicenter, adaptive randomized clinical trial. Pancreatology, 2020, 20(3): 369-376.
13.	Nagy A, Juhász MF, G?rbe A, et al. Glucose levels show independent and dose-dependent association with worsening acute pancreatitis outcomes: post-hoc analysis of a prospective, international cohort of 2 250 acute pancreatitis cases. Pancreatology, 2021, 21(7): 1237-1246.
14.	金洪忠, 趙凱亮, 梅方超, 等. NLRP3炎性小體與急性胰腺炎的研究進展. 中國普外基礎與臨床雜志, 2019, 26(5): 606-610.
15.	Qiu M, Zhou X, Zippi M, et al. Comprehensive review on the pathogenesis of hypertriglyceridaemia-associated acute pancreatitis. Ann Med, 2023, 55(2): 2265939. doi: 10.1080/07853890.2023.2265939.
16.	黃睿, 廖靜, 張懷蓉, 等. 高脂血癥性和膽源性重癥急性胰腺炎臨床特點及預后對比分析. 檢驗醫學與臨床, 2024, 21(18): 2633-2636.
17.	張冰, 孫秋, 杜麗明, 等. 前瞻性隊列研究—甘油三酯葡萄糖指數與急性胰腺炎發病風險. 實用醫學雜志, 2023, 39(23): 3116-3119.
18.	李金強, 惠亮亮. 急性胰腺炎患者腸道菌群的研究進展. 中國微生態學雜志, 2024, 36(12): 1480-1484.
19.	胡凡博, 周衛華, 王文兒. 腸道菌群與急性胰腺炎相關性的研究進展. 養生保健指南, 2023(1): 134-136.
20.	López-Montoya P, Cerqueda-García D, Rodríguez-Flores M, et al. Association of gut microbiota with atherogenic dyslipidemia, and its impact on serum lipid levels after bariatric surgery. Nutrients, 2022, 14(17): 3545. doi: 10.3390/nu14173545.
21.	朱翠宇, 周菲菲, 楊紅麗, 等. 腸道菌群失衡與重癥急性胰腺炎的關系. 山東第一醫科大學 (山東省醫學科學院) 學報, 2024, 45(7): 418-422.
22.	Wang M, Ma G, Li Y, et al. Potential modulatory roles of gut microbiota and metabolites in the associations of macronutrient-to-physical activity ratios with dyslipidemia. J Am Heart Assoc, 2025, 14(10): e040042. doi: 10.1161/JAHA.124.040042.
23.	Jahdkaran M, Sistanizad M. From lipids to glucose: investigating the role of dyslipidemia in the risk of insulin resistance. J Steroid Biochem Mol Biol, 2025, 250: 106744. doi: 10.1016/j.jsbmb.2025.106744.
24.	Hu X, Gong L, Zhou R, et al. Variations in gut microbiome are associated with prognosis of hypertriglyceridemia-associated acute pancreatitis. Biomolecules, 2021, 11(5): 695. doi: 10.3390/biom11050695.
25.	李燕, 吳浩, 鄧一蕓, 等. 重癥急性胰腺炎大鼠腸黏膜屏障及腸道菌群的變化. 生物醫學工程學雜志, 2015, 32(2): 412-417.
26.	李雪洋, 祝蔭. 腸道菌群失衡在急性胰腺炎腸黏膜屏障損傷中的作用. 中國實用內科雜志, 2021, 41(1): 14-17.
27.	張海洋, 宋展, 王鑫, 等. 益生菌、合生元對重癥急性胰腺炎小鼠腸道菌群的影響. 中華實驗外科雜志, 2020, 37(3): 473-476.
28.	呂彥青, 李嘉杰, 劉坤禹, 等. 急性胰腺炎患者腸道菌群變化及益生菌的應用. 臨床肝膽病雜志, 2023, 39(12): 2970-2977.
29.	Li X, Zheng P, Zou Y, et al. Dietary inulin ameliorates obesity-induced severe acute pancreatitis via gut-pancreas axis. Gut Microbes, 2024, 16(1): 2436949. doi: 10.1080/19490976.2024.2436949.
30.	Wang J, Jiang M, Hu Y, et al. Lactulose regulates gut microbiota dysbiosis and promotes short-chain fatty acids production in acute pancreatitis patients with intestinal dysfunction. Biomed Pharmacother, 2023, 163: 114769. doi: 10.1016/j.biopha.2023.114769.
31.	Liu LW, Xie Y, Li GQ, et al. Gut microbiota-derived nicotinamide mononucleotide alleviates acute pancreatitis by activating pancreatic SIRT3 signalling. Br J Pharmacol, 2023, 180(5): 647-666.
32.	劉潔, 羅新宇, 裴博亮, 等. 三甲胺N-氧化物及其前體與胰腺疾病易感性的效應分析. 中華危重病急救醫學, 2024, 36(9): 950-956.
33.	Zhang Y, Liu J, Zhang X, et al. Rhein alleviates acute pancreatitis by inhibiting TMAO-mediated inflammatory signaling pathways and reducing acinar cell injury. J Adv Res, 2025: S2090-1232(25)00952-X. doi: 10.1016/j.jare.2025.11.056.
34.	Li G, Liu L, Lu T, et al. Gut microbiota aggravates neutrophil extracellular traps-induced pancreatic injury in hypertriglyceridemic pancreatitis. Nat Commun, 2023, 14(1): 6179. doi: 10.1038/s41467-023-41950-y.
35.	Guo QQ, Wu XD, Lin H. The role of intestinal microbiota and its metabolite short-chain fatty acids in hypertriglyceridemia-associated acute pancreatitis. Front Microbiol, 2025, 16: 1667075. doi: 10.3389/fmicb.2025.1667075.
36.	趙夢琦, 崔夢妍, 范妙言, 等. 腸道菌群對急性壞死性胰腺炎小鼠肺損傷的影響. 中華胰腺病雜志, 2025, 25(2): 126-133.
37.	Valdez-Hernández P, Pérez-Díaz I, Soriano-Rios A, et al. Pancreatogenic diabetes, 2 onset forms and lack of metabolic syndrome components differentiate it from type 2 diabetes. Pancreas, 2021, 50(10): 1376-1381.
38.	Valenzuela-Vallejo L, Meléndrez-Vásquez D, Durán-Ventura P, et al. Severe hypertriglyceridemia as a cause of necrotizing pancreatitis in a pediatric patient with familial hyperchylomicronemia syndrome: a case report. SAGE Open Med Case Rep, 2022, 10: 2050313X221109972. doi: 10.1177/2050313X221109972.
39.	郭海閣. 腸道菌群變化情況與急性胰腺炎易位感染的相關性. 河南醫學研究, 2023, 32(18): 3312-3315.
40.	石衛華, 高偉杰, 向云霞, 等. 基于腸道微生態探討中醫藥治療重癥急性胰腺炎的研究進展. 現代醫藥衛生, 2024, 40(15): 2631-2635.
41.	馬嘉陽, 康大鵬, 李文星. 益生菌調節腸道菌群治療重癥急性胰腺炎的研究進展. 現代消化及介入診療, 2022, 27(2): 248-251.

1. Kiss L, F?r G, Pisipati S, et al. Mechanisms linking hypertriglyceridemia to acute pancreatitis. Acta Physiol (Oxf), 2023, 237(3): e13916. doi: 10.1111/apha.13916.
2. Fu ZH, Zhao ZY, Liang YB, et al. Impact of metabolic syndrome components on clinical outcomes in hypertriglyceridemia-induced acute pancreatitis. World J Gastroenterol, 2024, 30(35): 3996-4010.
3. Deng H, Peng K, Zhang L, et al. Clinical outcomes in a multicenter cohort involving 919 patients with hypertriglyceridemia-associated acute pancreatitis. Am J Gastroenterol, 2025, 120(10): 2405-2414.
4. Song XF, Liu Y, Fei QM, et al. Potential influence of gut microbiota on the process of hypertriglyceridemia-aggravated acute pancreatitis. World J Gastroenterol, 2026, 32(1): 114479. doi: 10.3748/wjg.v32.i1.114479.
5. Shaka H, Asotibe JC, Achebe I, et al. Higher inpatient morbidity and mortality in biliary pancreatitis compared to hypertriglyceridemia-induced pancreatitis: a nationwide retrospective study. Cureus, 2020, 12(9): e10351. doi: 10.7759/cureus.10351.
6. Fan Z, Li J, Wu D. Hypertriglyceridemic pancreatitis: perspectives from China. Curr Opin Gastroenterol, 2025, 41(5): 348-354. doi: 10.1097/MOG.0000000000001123.
7. Mosztbacher D, Hanák L, Farkas N, et al. Hypertriglyceridemia-induced acute pancreatitis: a prospective, multicenter, international cohort analysis of 716 acute pancreatitis cases. Pancreatology, 2020, 20(4): 608-616.
8. Goldberg RB, Chait A. A comprehensive update on the chylomicronemia syndrome. Front Endocrinol (Lausanne), 2020, 11: 593931. doi: 10.3389/fendo.2020.593931.
9. Corrado MJ, Kovacevic MP, Dube KM, et al. The incidence of propofol-induced hypertriglyceridemia and identification of associated risk factors. Crit Care Explor, 2020, 2(12): e0282. doi: 10.1097/CCE.0000000000000282.
10. Pu N, Yang Q, Shi XL, et al. Gene-environment interaction between APOA5 c. 553G>T and pregnancy in hypertriglyceridemia-induced acute pancreatitis. J Clin Lipidol, 2020, 14(4): 498-506.
11. Fei F, Boshell N, Williams LA 3rd. Predictability and efficacy of therapeutic plasma exchange for hypertriglyceridemia induced acute pancreatitis. Transfus Apher Sci, 2020, 59(2): 102699. doi: 10.1016/j.transci.2019.102699.
12. Zádori N, Gede N, Antal J, et al. EarLy Elimination of Fatty Acids iN hypertriglyceridemia-induced acuTe pancreatitis (ELEFANT trial): protocol of an open-label, multicenter, adaptive randomized clinical trial. Pancreatology, 2020, 20(3): 369-376.
13. Nagy A, Juhász MF, G?rbe A, et al. Glucose levels show independent and dose-dependent association with worsening acute pancreatitis outcomes: post-hoc analysis of a prospective, international cohort of 2 250 acute pancreatitis cases. Pancreatology, 2021, 21(7): 1237-1246.
14. 金洪忠, 趙凱亮, 梅方超, 等. NLRP3炎性小體與急性胰腺炎的研究進展. 中國普外基礎與臨床雜志, 2019, 26(5): 606-610.
15. Qiu M, Zhou X, Zippi M, et al. Comprehensive review on the pathogenesis of hypertriglyceridaemia-associated acute pancreatitis. Ann Med, 2023, 55(2): 2265939. doi: 10.1080/07853890.2023.2265939.
16. 黃睿, 廖靜, 張懷蓉, 等. 高脂血癥性和膽源性重癥急性胰腺炎臨床特點及預后對比分析. 檢驗醫學與臨床, 2024, 21(18): 2633-2636.
17. 張冰, 孫秋, 杜麗明, 等. 前瞻性隊列研究—甘油三酯葡萄糖指數與急性胰腺炎發病風險. 實用醫學雜志, 2023, 39(23): 3116-3119.
18. 李金強, 惠亮亮. 急性胰腺炎患者腸道菌群的研究進展. 中國微生態學雜志, 2024, 36(12): 1480-1484.
19. 胡凡博, 周衛華, 王文兒. 腸道菌群與急性胰腺炎相關性的研究進展. 養生保健指南, 2023(1): 134-136.
20. López-Montoya P, Cerqueda-García D, Rodríguez-Flores M, et al. Association of gut microbiota with atherogenic dyslipidemia, and its impact on serum lipid levels after bariatric surgery. Nutrients, 2022, 14(17): 3545. doi: 10.3390/nu14173545.
21. 朱翠宇, 周菲菲, 楊紅麗, 等. 腸道菌群失衡與重癥急性胰腺炎的關系. 山東第一醫科大學 (山東省醫學科學院) 學報, 2024, 45(7): 418-422.
22. Wang M, Ma G, Li Y, et al. Potential modulatory roles of gut microbiota and metabolites in the associations of macronutrient-to-physical activity ratios with dyslipidemia. J Am Heart Assoc, 2025, 14(10): e040042. doi: 10.1161/JAHA.124.040042.
23. Jahdkaran M, Sistanizad M. From lipids to glucose: investigating the role of dyslipidemia in the risk of insulin resistance. J Steroid Biochem Mol Biol, 2025, 250: 106744. doi: 10.1016/j.jsbmb.2025.106744.
24. Hu X, Gong L, Zhou R, et al. Variations in gut microbiome are associated with prognosis of hypertriglyceridemia-associated acute pancreatitis. Biomolecules, 2021, 11(5): 695. doi: 10.3390/biom11050695.
25. 李燕, 吳浩, 鄧一蕓, 等. 重癥急性胰腺炎大鼠腸黏膜屏障及腸道菌群的變化. 生物醫學工程學雜志, 2015, 32(2): 412-417.
26. 李雪洋, 祝蔭. 腸道菌群失衡在急性胰腺炎腸黏膜屏障損傷中的作用. 中國實用內科雜志, 2021, 41(1): 14-17.
27. 張海洋, 宋展, 王鑫, 等. 益生菌、合生元對重癥急性胰腺炎小鼠腸道菌群的影響. 中華實驗外科雜志, 2020, 37(3): 473-476.
28. 呂彥青, 李嘉杰, 劉坤禹, 等. 急性胰腺炎患者腸道菌群變化及益生菌的應用. 臨床肝膽病雜志, 2023, 39(12): 2970-2977.
29. Li X, Zheng P, Zou Y, et al. Dietary inulin ameliorates obesity-induced severe acute pancreatitis via gut-pancreas axis. Gut Microbes, 2024, 16(1): 2436949. doi: 10.1080/19490976.2024.2436949.
30. Wang J, Jiang M, Hu Y, et al. Lactulose regulates gut microbiota dysbiosis and promotes short-chain fatty acids production in acute pancreatitis patients with intestinal dysfunction. Biomed Pharmacother, 2023, 163: 114769. doi: 10.1016/j.biopha.2023.114769.
31. Liu LW, Xie Y, Li GQ, et al. Gut microbiota-derived nicotinamide mononucleotide alleviates acute pancreatitis by activating pancreatic SIRT3 signalling. Br J Pharmacol, 2023, 180(5): 647-666.
32. 劉潔, 羅新宇, 裴博亮, 等. 三甲胺N-氧化物及其前體與胰腺疾病易感性的效應分析. 中華危重病急救醫學, 2024, 36(9): 950-956.
33. Zhang Y, Liu J, Zhang X, et al. Rhein alleviates acute pancreatitis by inhibiting TMAO-mediated inflammatory signaling pathways and reducing acinar cell injury. J Adv Res, 2025: S2090-1232(25)00952-X. doi: 10.1016/j.jare.2025.11.056.
34. Li G, Liu L, Lu T, et al. Gut microbiota aggravates neutrophil extracellular traps-induced pancreatic injury in hypertriglyceridemic pancreatitis. Nat Commun, 2023, 14(1): 6179. doi: 10.1038/s41467-023-41950-y.
35. Guo QQ, Wu XD, Lin H. The role of intestinal microbiota and its metabolite short-chain fatty acids in hypertriglyceridemia-associated acute pancreatitis. Front Microbiol, 2025, 16: 1667075. doi: 10.3389/fmicb.2025.1667075.
36. 趙夢琦, 崔夢妍, 范妙言, 等. 腸道菌群對急性壞死性胰腺炎小鼠肺損傷的影響. 中華胰腺病雜志, 2025, 25(2): 126-133.
37. Valdez-Hernández P, Pérez-Díaz I, Soriano-Rios A, et al. Pancreatogenic diabetes, 2 onset forms and lack of metabolic syndrome components differentiate it from type 2 diabetes. Pancreas, 2021, 50(10): 1376-1381.
38. Valenzuela-Vallejo L, Meléndrez-Vásquez D, Durán-Ventura P, et al. Severe hypertriglyceridemia as a cause of necrotizing pancreatitis in a pediatric patient with familial hyperchylomicronemia syndrome: a case report. SAGE Open Med Case Rep, 2022, 10: 2050313X221109972. doi: 10.1177/2050313X221109972.
39. 郭海閣. 腸道菌群變化情況與急性胰腺炎易位感染的相關性. 河南醫學研究, 2023, 32(18): 3312-3315.
40. 石衛華, 高偉杰, 向云霞, 等. 基于腸道微生態探討中醫藥治療重癥急性胰腺炎的研究進展. 現代醫藥衛生, 2024, 40(15): 2631-2635.
41. 馬嘉陽, 康大鵬, 李文星. 益生菌調節腸道菌群治療重癥急性胰腺炎的研究進展. 現代消化及介入診療, 2022, 27(2): 248-251.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Latest ArticlesResearch progress on the interaction between dyslipidemia and gut microbiota in the pathogenesis and progression of hypertriglyceridemia-induced acute pancreatitis and its diagnostic and therapeutic strategies

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