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Research suggests a potential connection between the gut microbiota and AP, which could be mediated by bacterial metabolites, immune cells, and inflammatory factors. This is supported by observations of microbial imbalance and higher intestinal permeability in patients with AP. In addition, studies have shown that HTG-induced changes in gut microbiota can worsen AP by negatively impacting the host metabolism, immune response, and function of the intestinal barrier. In this review, we summarize recent clinical and animal studies on the role and mechanism of gut microbiota in the severity of AP aggravated by HTG. 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