本文报道1例经GeneXpert MTB/RIF（结核分枝杆菌rpoB基因和突变检测）检查证实的结核性心包积液患者，并结合相关文献病例进行分析探讨。本例患者在疾病初期，常规抗感染无效，病原菌寻找无果，并排除了肿瘤以及其他病因，临床考虑为结核性心包积液，但心包积液反复检测抗酸杆菌为阴性。对患者心包积液进行GeneXpert MTB/RIF检查，获得阳性（极低）结果。遂予患者抗结核治疗，2周后患者心包积液降至少量，症状明显好转；3个月后，心包积液降至极少量，症状消失。该病例的诊治过程提示，临床诊断结核性心包积液时，除行传统的抗酸杆菌涂片观察和分枝杆菌培养，还要积极在早期应用其他检查方法，如测定心包积液腺苷脱氨酶(adenosine deaminase，ADA)、心包积液GeneXpert MTB/RIFF检查以及血液结核感染γ干扰素释放试验（interferon-gamma release assay，IGRA)。

This paper reported a case of tuberculous pericardial effusion which was confirmed by GeneXpert MTB/RIF (Mycobacterium tuberculosis rpoB gene and mutation detection). During the early stage of the diagnosis, the routine anti-infection was ineffective, the pathogenic bacteria was not founded in the case, and tumor or other causes were excluded. The clinical diagnosis was considered as tuberculous pericardial effusion, while multiple tests for acid-fast bacilli was negative. The patient’s pericardial effusion was used to perform GeneXpert MTB/RIF test, and positive (very low dose) result was obtained. Through anti-tuberculous treatment, the pericardial effusion of the patient decreased to a small amount and the symptoms improved significantly after 2 weeks. And 3 months later, the symptoms disappeared. The diagnosis and treatment of the patient suggested that multiple methods should be actively applied during the early stage of clinical diagnosing tuberculous pericardial effusion. Beside traditional acid-fast bacillus smear and mycobacterium culture, the adenosine deaminase (ADA) and GeneXpert MTB/RIFF tests for pericardial effusion and interferon-gamma release assay (IGRA) for blood should be considered.