Abstract: Abstract: Objective　To analysis the diagnostic efficacy and safety of closed pleural biopsy (CPB), ultrasound guided pleural biopsy (USPB) and medical thoracoscopy (MTPB) in tuberculous pleurisy, and to provide more basis for clinical diagnosis and treatment. Methods　A total of 208 patients diagnosed with tuberculous pleurisy were selected and divided into the USPB group (n=43), the CPB group (n=69) and the MTPB group (n=96). The basic information, auxiliary examination and biopsy data of patients were collected. Propensity score matching (PSM) was performed before and after analysis in the three groups. The diagnostic performance (success rate and positive rate of diagnosis), length of hospital stay and postoperative complications were compared between the three groups. Results　Before PSM, compared with the MTPB group, a lower success rate of sampling was found in the CPB group (P＜0.05), while there was no significant difference in the diagnostic positive rate between the three groups (P＞0.05). After PSM, there were no significant differences in the success rate of sampling or the positive rate of diagnosis between the three groups (P＞0.05). Before PSM, compared with the MTPB group, the proportion of subcutaneous emphysema, pain, and iatrogenic pneumothorax were lower in the USPB group and the CPB group (P＜0.01), while there was no significant difference in complication between the USPB group and the CPB group (P＞0.05). After PSM, compared with the MTPB group, the proportion of subcutaneous emphysema and pain was lower in the USPB group and the CPB group (P＜0.05), but no significant difference in the proportion of iatrogenic pneumothorax between the three groups (P＞0.05). Compared with the USPB group, a higher proportion of pain was found in the CPB group (P＜0.05). The length of hospital stay was longer in the MTPB group than that in the USPB group and the CPB group before and after PSM (P＜0.05), while there was no significant difference in the hospitalization days between the CPB group and the USPB group (P＞0.05). Conclusion　For the diagnosis of tuberculous pleurisy, USPB and CPB have the same diagnostic efficacy as MTPB, with fewer complications and shorter hospital stay. However, in units with ultrasound-guided conditions, USPB should be preferred in the pleural biopsy.

Key words: tuberculosis, pleural, biopsy, thoracoscopy, closed pleural biopsy, ultrasound guided pleural biopsy, medical thoracoscopy, propensity score matching