本文分析４０例难治性矽肺结核的形成原因及对诊断标准的探讨。认为其主要原因系不规则化疗（７０．０％）严重合并症、（３２．５％）以及频繁肺部感染（５７．５％）。认为，凡经正规化疗超过两年痰菌仍阳性者，为难治性矽肺结核主要的诊断依据。文中分析了矽肺结核痰培养阳性率较低原因，认为对难治性矽肺结核的诊断，Ｘ线表现不可忽视。 This article analyzes the formation of 40 cases of refractory silicotic tuberculosis and explore the diagnostic criteria. The main reason is that the incidence of irregular chemotherapy (70.0%) with severe comorbidity (32.5%) and frequent lung infections (57.5%). That, who have been more than two years after formal chemotherapy sputum is still positive for refractory silicosis of the main basis for the diagnosis of tuberculosis. In this paper, the reason for the low positive rate of sputum culture in silicotic tuberculosis is analyzed. It is considered that the diagnosis of refractory silicotic pulmonary tuberculosis can not be neglected.