AIM:To investigate a formalized therapeutic guideline forhyperlipidemic severe acute pancreatitis (HL-SAP).METHODS:Thirty-two consecutive patients with severeacute pancreatitis were included in the clinical trial.All ofthem met the following five criteria for admission to thestudy,namely the Atlanta classification and stratificationsystem for the clinical diagnosis of SAP,APACHEII scoremore than 8,time interval for therapeutic intervention lessthan 72 hours after onset of the disease,serum triglyceride(TG) level 6.8 mmol/l or over,and exclusion of other etiologies.They were divided into severe acute pancreatitis group (SAP,22 patients) and fulminant severe acute pancreatitis group(FSAP,10 patients).Besides the conventional therapeuticmeasures,Penta-association therapywas also applied in thetwo groups,which consisted of blood purification (adsorptionof triglyceride and hemofiltration),antihyperlipidemic agents(fluvastatin or lipanthyl),low molecular weight heparin(fragmin),insulin,topical application of Pixiao (a traditionalChinese medidne) over the whole abdomen.Serum triglyceride,pro-inflammatory cytokines and anti-inflammatory cytokineswere determined before blood purification (PF),at the endof blood purification (AFE) and on the 7~(th) day after onset ofthe disease (AF7) respectively.Simultaneously,severity ofthe diseases was assessed by the APACHE Ⅱ system.Prognosis was evaluated by non-operation cure rate,absorption rate of pseudocyst,time interval pseudocystabsorption,hospital stay and survival rate.RESULTS:Serum triglyceride level (mmol/L),TNFα (U/ml)concentration and APACHE Ⅱ score were significantlydecreased (P<0.05) at AFE and AF7,as compared with PF.However,serum IL-10 concentration (pg/ml) was increasedsignificantly (P<0.001) at AFE,and decreased significantly(P<0.05) at AF7 when compared with PF.Operations:TheFirst surgical intervention time was 55.8±42.6 days in SAPgroup (5 patients) and 12.2±6.6 days in FSAP group (7 patients),there was a significant difference between the two groups(P=0.02).The number of operations in the two groups was1.33±0.5 vs3.5±1.2 (P=0.0037),respectively.Prognosis:Non-operation cure rate,absorption rate of pseudocyst,hospitalstay and survival rate in SAP group and FSAP group were100 % (22/22) vs 11.1% (1/9),77.3 % (17/22) vs 11.1%(1/9),54.2±35.9 vs99.1±49.5 days (P=0.008) and 100 %(22/22) vs66.7 % (6/9) (P=0.0044).The time for absorptionof pseudocyst was 135.1±137.5 days in SAP group. CONCLUSION:Penta-association therapy is an effectiveguideline in the treatment of hyperlipidemic severe acutepancreatitis at its early stage (within 72 hours). AIM: To investigate a formalized therapeutic guideline for hyperlipidemic severe acute pancreatitis (HL-SAP). METHODS: Thirty-two consecutive patients with severeacute pancreatitis were included in the clinical trial. All of the five met the following five criteria for admission to the study, namely the Atlanta classification and stratificationsystem for the clinical diagnosis of SAP, APACHEII scoremore than 8, time interval for therapeutic intervention lessthan 72 hours after onset of the disease, serum triglyceride (TG) level 6.8 mmol / l or over, and exclusion of other etiologies.They were Pestal the conventional therapeutic measures, Penta-association therapy was also applied in the two groups, which consisted of blood purification (adsorption of triglyceride and hemofiltration ), antihyperlipidemic agents (fluvastatin or lipanthyl), low molecular weight heparin (fragmin), insulin, topic al application of Pixiao (a traditional Chinese medidne) over the whole abdomen. Serum triglyceride, pro-inflammatory cytokines and anti-inflammatory cytokineswere determined before blood purification (PF), at the endof blood purification (AFE) and on the 7th (th) day after onset of the disease (AF7). S. Simultaneously, severity of the diseases was assessed by the APACHE II system. Prognosis was evaluated by non-operation cure rate, absorption rate of pseudocyst, time interval pseudocystabsorption, hospital stay and survival rate .RESULTS: Serum triglyceride level (mmol / L), TNFα (U / ml) concentration and APACHE II score were significantly decreased (P <0.05) at AFE and AF7, as compared with PF.However, serum IL- 10 concentration (P <0.05) at AF7 when compared with PF. Operations: The First Intervention time was 55.8 ± 42.6 days in SAPgroup (5 patients) and 12.2 ± 6.6 days in FSAP group ( 7 patients), there was a signi ficantThe number of operations in the two groups was 1.33 ± 0.5 vs. 3.5 ± 1.2 (P = 0.0037), respectively. Prognosis: Non-operation cure rate, absorption rate of pseudocyst, hospitalstay and survival rate in SAP group and FSAP group were 100% (22/22) vs 11.1% (1/9), 77.3% (17/22) vs 11.1% (1/9), 54.2 ± 35.9 vs 99.1 ± 49.5 The time for absorption of pseudocyst was 135.1 ± 137.5 days in SAP group. CONCLUSION: Penta-association therapy is (P = 0.008) and 100% (22/22) vs 66.7% (6/9) an effective guideline in the treatment of hyperlipidemic severe acute pancreatitis at its early stage (within 72 hours).