Objective To identify the main factors affecting the active state of lesions in patients with hepatic cystic echinococcosis and provide the basis for decision-making to improve the diagnosis and treatment of cystic echinococcosis. Methods A total of 251 patients with hepatic cystic echinococcosis receiving surgical treatment at the First Affiliated Hospital of Xinjiang Medical University from between January 2018 and June 2020 were enrolled, and their demographic information and clinical data were collected, Based on the imaging and biological characteristics, the cysts classified as CE1, CE2 and CE3 were grouped as active group, and CE4 and CE5 inactive group. Using the cyst activity as the dependent variable, univariate analysis was performed, based on which unconditinal logistic regression model was constructed to analyze the independent factors influencing the cyst activity status. Results In this study, clinical data of 251 patients with hepatic cystic echinococcosis meeting the inclusion criteria were collected, with 57.0% (143 cases) female and 43.0% (108 cases) male. The age of the patients ranged from 4 to 85 years old, and the average age was (41.31 ± 15.05) years old. Most of the patients had a low educational level, with high school or below accounting for 79.3% (199 cases); the rural resident accounted for 66.9% (168 cases), which is higher than that of the urban resident 33.1% (83 cases). The percentage of CE in Han nationality was 42.2% (106 cases), while that in other minority nationalities was 57.8% (145 cases). The percentage of patients with their first infection was 78.1% (196 cases), which is higher than that of the recurrent infection (21.9%, 55 cases). The active lesions accounted for 76.9% (193 cases), and the inactive lesions accounted for 23.1% (58 cases). The results of the univariate analysis showed that there were significant differences among patients with different age groups, ethnic groups, the active state of lesions between patients with hepatic cystic echinococcosis and those without recurrence, the number of lesions, the size of lesions, red blood cell count, prothrombin time, direct bilirubin and alkaline phosphatase (χ² = 17.110, 7.797, 2.906, 4.702, 16.520, Z = -1.989, 2.446, 2.003, 1.914, P < 0.1). Unconditional Logistic regression results showed that the main factors affecting the active status of lesions in patients with hepatic cystic echinococcosis were age and lesion size. Larger lesions tend to occur in younger patients(P < 0.05). Conclusion The analysis on the clinical data of 251 hepatic cystic echinococcosis patients receiving surgical treatment demonstrated that younger age and larger cyst size were the independent factors affecting the activity status of cysts.