The complex and diverse natural environment is the main reason for the spatial difference and heterogeneity of settlements in mountainous areas, which has a profound impact on the spatial governance and sustainable development of settlements. According to the land change survey data of Tianzhu county in 2018, the spatial distribution pattern and its forming factors of settlements were analyzed by the spatial "hot spot" detection, the minimum cumulative resistance value model (MCR) and binary logistic regression. The results show that: (1) the overall distribution of settlements is agglomeration. And it is high in the southeast and low in the northwest in the spatial pattern. (2) The kernel density estimate of settlement patches is high in the southeast and low in the northwest, which causes the formation of two typical distribution areas: "southeast intensive" and "northwest sparse". This phenomenon presents a "core-edge" structure. Meanwhile, settlement "hot spot" detection shows that there is a significant spatial difference in settlement patterns. Huazangsi town showed large patches of high density, while other towns showed small patches of medium and low density. (3) The average density of settlement patches has a significant effect on the results of grouping analysis. The settlement type is dominated by medium and low density patches. And it is affected by the wide distribution range of the alpine climate zone and the sparse settlement in the alpine region covers a large area. (4) The influencing factors of settlement spatial pattern were analyzed by statistical analysis and logistic regression analysis. We identified quantitatively that topographic conditions, land resource allocation and precipitation conditions had the most significant effect on the density of settlement distribution. Transportation endowment and accessibility play a crucial role in the optimization of settlement pattern in county areas.