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Objective To evaluate the diagnostic value of interferon-γ release assay of blood and pleural effusion for tuberculous pleurisy. Methods Fifty-six adult patients with suspected tuberculous pleurisy were enrolled in our study. The blood and pleural effusion interferon-γ release assay were measured by T-SPOT.TB test in 38 pleural tuberculosis patients and 18 non-tuberculous pleurisy controls. The diagnostic sensitivity, specificity, predictive value of T-SPOT.TB in pleural effusion mononuclear cells (PE-MC) and peripheral mononuclear cells (PBMC) were analyzed. Results The sensitivities and specificities, positive predictive values and negative predictive values, respectively, of the PE-MC and PBMC for diagnosing were as follows: 86.5%(95% confidence interval[CI] 71.2%-95.5%) and 100%(95%CI 90.5%-100%); 52.9%(95%CI 27.8%-77.0%) and 35.3%(95%CI 14.2%¬61.7%); 80.0%(95%CI 64.4%-90.9%) and 77.1%(95%CI 62.7%-88.0%); 64.3%(95%CI 35.1%-87.2%) and 100%(95%CI 54.1%¬100%). By ROC curve analysis, a cut-off value of 47SFC/2.5×105 cells in PE-MC showed a sensitivity of 89.2% and a specificity of 88.2%. Conclusion T-SPOT.TB in PE-MC could be an accurate diagnostic method for tuberculous pleurisy in TB endemic settings. Moreover, 47SFC/2.5×105 cells might be the optimal cut-off value for diagnosing tuberculous pleurisy. DOI: 10.11855/j.issn.0577-7402.2018.01.11