Pine wilt disease, caused by Bursaphelenchus xylophilus, is a major quarantine forest disease that has resulted in massive economic losses as well as ecological disaster. Therefore, it is imperative to study the defence response mechanism of host pine trees to infection by B. xylophilus to understand further the internal causes of pine tree death and to find control strategies. For many years, systematic research has been carried out on the pathophysiological response of pine trees to pine wilt disease. However, due to the complexity of the occurrence and development of pine wilt disease, the specific response mechanisms of different tree species have remained unclear. This paper attempts to provide an overview of the resistance mechanism of host pine trees against B. xylophilus infection through the perspectives of histopathological characteristics, physiological and biochemical responses, and molecular response mechanisms, which provide a theoretical reference for further investigating the disease resistance mechanism of pine trees to pine wilt disease and lay the foundation for the prevention and quarantine of pine wilt disease.