〔Abstract〕 Objective To compare the differences in lipid metabolism between platinum-resistant and platinum-sensitive ovarian cancer patients at stage Ⅲ-Ⅳ, to analyze the differential intestinal flora using 16S rRNA sequencing, and to explore the associations among intestinal flora, lipid metabolism characteristics and platinum resistance in ovarian cancer. Methods Patients diagnosed with ovarian cancer at stage Ⅲ-Ⅳ through surgical pathology were selected, including a platinum-resistant group(11 cases) and a platinum-sensitive group(11 cases). The differences in lipid metabolism between the two groups were compared. The differences in gut microbiota between the two groups were investigated using fecal 16S rRNA sequencing. The association among gut microbiota, lipid metabolism characteristics, and platinum resistance in ovarian cancer was analyzed. Results Significant differences were observed in lipid metabolism-related indicators[total cholesterol(TC), high-density lipoprotein cholesterol(HDL-C), non-high-density lipoprotein cholesterol(n-HDL), low-density lipoprotein cholesterol(LDL-C), apolipoprotein(B)] between the two groups, with higher levels in the platinum-resistant group. The Shannon index(P=0.008 3) and Simpson index(P=0.008 2) both showed higher diversity of gut microbiota in platinum-resistant ovarian cancer patients compared to the platinum-sensitive group. However, based on OTUs species clustering and relative abundance statistics, certain bacterial abundances differed significantly between the groups. Species such asParabacteroides,Akkermansia,Blautia,Lachnoclostridium,Fusicatenibacter, andMegamonashad significantly higher abundances in the platinum-sensitive ovarian cancer group, andAkkermansia(a lipid metabolism-related bacterial group) was the most prevalent. Conclusion The platinum-resistant group of ovarian cancer exhibits significantly higher levels of lipid metabolism and gut microbiota diversity compared to the platinum-sensitive group. This suggests that the increase in lipid metabolism levels and fecal microbiota diversity may be associated with the development of platinum resistance. However, certain microbial taxa are reduced in abundance in the platinum-resistant group, such as the distinctAkkermansiagenus(a lipid metabolism-related microbial community), which may serve as one of the factors inducing platinum-resistance in ovarian cancer.