Objective：This study aims to analyze the epidemiological characteristics and temporal trends of pulmonary tuberculosis (PTB)in Nanjing from 2005 to 2020 and provide scientific evidence for tuberculosis prevention strategy. Methods：Data of registered PTB in Nanjing from 2005 to 2020 was collected through the National Tuberculosis Information Management System. The Joinpoint regression model was used to estimate the annual percent change(APC)as well as the average annual percent change(AAPC)and the 95% CI，respectively. Results：A total of 51 624 PTB were reported with the reported incidence dropped from 71.86/100 000 to 26.08/100 000 and presented overall declining trend，with an average annual decline of 6.47%(AAPC=-6.47，95%CI：-9.84~-2.97， P ＜ 0.001). The reported incidence and the proportion of smear - positive PTB annually decreased by 8.72%(AAPC=- 8.72，95%CI： -14.71~-2.32，P= 0.008)and 3.37%(AAPC=-3.37，95%CI：-4.60~-2.12，P ＜ 0.001)，respectively. There was no significant change in reported incidence of bacteriological - positive PTB(AAPC=- 6.37，95% CI：- 15.21~3.41，P=0.194). However，the proportion of bacteriological-positive PTB decreased and then increased with 2016 as the turning point. The reported incidence of PTB in the males and females both presented significant declining trend(AAPC=- 6.80，95% CI：- 10.13~- 3.35，P ＜ 0.001；AAPC=- 6.88，95% CI： -8.54~-5.18，P ＜ 0.001)，and there was no significant difference in the decline rate between the males and females(P=0.968). The proportion of the female cases increased(AAPC=0.99，95%CI：0.31~1.67，P=0.008)，while the proportion of the male cases decreased (AAPC=-0.42，95%CI：-0.73~-0.10，P=0.013)annually. The reported incidence rate of all age groups of ≥ 30 years old showed a downward trend，while the reported incidence rate changes of groups of 0~＜ 15 and 15~＜ 30 years old had no statistical significance. In addition，the proportion of 15~＜30 years old age group showed an increasing trend(AAPC=1.66，95%CI：0.28~3.07，P=0.019)while there was no significant change trend of all the other age groups. The PTB reported incidence in the main urban districts and the suburban districtsall showed decreasing trend(AAPC=-8.42，95%CI：-15.60~-0.62，P=0.035；AAPC=-5.37，95%CI：-9.13~-1.46， P ＜ 0.008)，and there was no significant difference with respect to the decline rate(P=0.478). However，the proportion of patients in the central urban area has shown a downward trend(P ＜ 0.001)since 2009，while that in the non central urban area has shown an upward trend(P ＜ 0.001). Conclusion：The overall reported incidence of tuberculosis in Nanjing showed a downward trend from 2005 to 2020 and the pathogen positive rate increased annually since 2016. More effort should be paid to the 15~＜30 years old age group population，meanwhile the proportion of women and patients in non central urban areas is on the rise，which should be paid attention to.