〔Abstract〕 Objective To explore the value of acid-resistant smear microscopy combined with GeneXpert MTB/RIF system detection (Xpert detection for short) in the diagnosis of pulmonary tuberculosis. Methods 442 patients with suspected pulmonary tuberculosis in Xiangya Boai Rehabilitation Hospital from February 2020 to April 2022 were examined by acid-resistant smear microscopy and Xpert detection respectively. Taking the clinical diagnosis results as the standard, the diagnostic efficacy of Xpert detection, acid-resistant smear microscopy and combined diagnosis were compared. Results The sensitivity, positive predictive value, negative predictive value and accuracy of combined test were significantly higher than those of Xpert detection and acidresistant smear microscopy, and the differences were statistically significant (P < 0.05). There was no significant difference in the specificity of the three methods (P > 0.05). Conclusion The combined detection of Xpert detection and acid-resistant smear microscopy can significantly improve the efficiency of a single detection method in the diagnosis of pulmonary tuberculosis.