Objective To analyze the factors affecting the diagnostic yield of ultrasound guided cutting needle pleural biopsy for tuberculous pleurisy. Methods A total of 200 cases of tuberculous pleurisy confirmed by pleural biopsy (206 biopsies) or during follow up in our hospital from March 2011 to December 2014 were enrolled in this retrospective study. The influencing factors for the diagnostic yield of ultrasound guided pleural biopsy were analyzed. Results The overall diagnostic yield was 79.6% (164/206) for ultrasound guided cutting needle biopsy for pleural tuberculosis. Patient’s age, disease duration, and pleural thickness had statistical significances for the diagnostic yield of pleural biopsy (P<0.05). Multivariate logistic regression analysis showed that the pleural thickness ≥3 mm, duration ≥21 d, and age ≥40 years were independent risk factors for the diagnostic yield. For the patients with pleural thickness ≥3 mm, the diagnostic yield of aspiration biopsy was approximately 5 times higher than those with the thickness ＜3 mm (OR=4.77, P=0.001). The yield was almost 4 times higher in the patients with duration ≥21 d than those with the duration ＜21 d (OR=3.65, P=0.018), and was almost 3 times higher in the patients younger than 40 years old than those older (OR=2.69, P=0.012). Conclusion Ultrasound guided cutting needle biopsy is a safe, simple, and economical approach with high diagnostic yield for tuberculous pleurisy. Age, disease duration and pleural thickness are the important factors to influence the diagnostic yield of pleural tuberculosis.