Abstract: Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis, primarily transmitted through respiratory droplets, and poses a significant global public health challenge. Despite the availability of vaccines and chemotherapy regimens, the emergence of drug resistance and high incidence rates continue to render the prevention and control situation severe. The intestinal microbiota modulates host immunity through metabolites such as short-chain fatty acids, influencing macrophage function, T-cell differentiation, and inflammatory responses, thereby regulating tuberculosis susceptibility, disease progression, and treatment responses. This review systematically summarized the role of intestinal microecology in immune regulation of tuberculosis and its potential application strategies, delved into the possible immune regulatory mechanisms, proposed that the interaction between intestinal microbiota and immune checkpoint inhibitors may serve as a warning for the clinical risk of tuberculosis reactivation, and analyzed the potential of intestinal microecology as a therapeutic target for tuberculosis.