chronic hepatitis b virus ( hbv ) infection is one of the most common and serious infections worldwide . according to the world health organization , approximately two billion people have been infected with hbv and more than 240 million of them suffer from chronic hbv infection . chronic hbv infection may be complicated by cirrhosis , hepatocellular carcinoma ( hcc ) , and end - stage liver disease [ 13 ] . all children with hbv infection should be monitored by physicians due to the risk of progression to chronicity , cirrhosis , and hcc . progression to chronicity and development of cirrhosis or hepatocellular carcinoma can be detected by invasive methods such as liver biopsy . galectin-3 ( gal-3 ) is a 30 kda protein that is important in many activities of malignant behaviors , including cancer cells and development of fibrosis . gal-3 may be important in the pathogenesis of liver fibrosis , as the previous literature suggest that the lack of gal-3 may be associated with resistance to liver fibrosis development . recently , some experimental disease models suggested that gal-3 was associated with the development of chronic liver disease secondary to inflammatory or toxic insults . gal-3 can stimulate the production of some cytokines and chemokines via cd98 through interactions with macrophages . gal-3 may play an important role in sustaining of hbv replication and may contribute to pathologic processes that resulted in chronic status in hbv infection . based on these data gal-3 was found to be crucial for promoting inflammation that may contribute in the progression of chronic infection and development of liver fibrosis . thus , gal-3 may be useful for monitoring the chronicity in different phases of hbv infection . to our knowledge , there is no study regarding gal-3 levels in children with chb . in this study , we investigated serum gal-3 levels in children with chb compared to inactive hbv carrier patients to help us understand whether gal-3 levels may be beneficial for discrimination and monitoring of hbv chronicity . thirty - two patients with chronic hepatitis b ( chb ) with no antiviral treatment and 30 inactive hbv carrier children with hepatitis b were followed up between july 2013 and december 2013 . patients with chronic hepatitis b were defined by the following criteria : 1 ) positive serum hepatitis b surface antigen ( hbsag ) lasting at least 6 months prior to obtaining of blood samples ; and 2 ) for hepatitis b e antigen ( hbeag ) positive patients [ serum hbv dna level 20 000 iu / ml and serum alt level 1.5upper limit of normal values ( uln ) ; for hbeag negative patients , serum hbv dna 2000 iu / ml and serum alt 1.5uln ] . inactive hbv carrier patients were defined by the following criteria : 1 ) positive serum hbsag from at least 6 months prior to obtaining of blood samples ; 2 ) serum hbv dna level < 2000 iu / ml and serum alt levels < uln ; and 3 ) negative serum hbeag . control subjects were recruited from children who applied for routine check - up or elective surgery such as hernia repair or circumcision . control subjects had no abnormal liver function or hepatitis b tests , and no history or findings of any systemic disease . the basic laboratory tests of all subjects including serum glucose , albumin , alanine aminotransferase ( alt ) , aspartate aminotransferase ( ast ) , gamma - glutamyl transferase ( ggt ) , total bilirubin ( tbil ) , prothrombin time ( pt ) and activated partial thromboplastin time ( aptt ) were recorded . patients that were under 2 years or older than 18 years of age were excluded from the study . patients that received hepatotoxic drugs or had other causes of acute or chronic hepatitis ( wilson disease , autoimmune hepatitis , 1-antitrypsin deficiency , metabolic disease and co - infection or superinfection of hepatitis d virus infection and hepatitis c infection ) were also excluded . informed consent was obtained from parents or legal guardians of the subjects and the study protocol was approved by the local ethics committee . serum glucose , albumin , alt , ast , ggt , tbil , pt , and aptt were measured by enzymatic colorimetric method using an abbot architect c16000 ( illinois , united states ) . serum gal-3 levels were measured by using a commercial quantitative enzyme - linked immune sorbent assay ( elisa ) ( eastbiopharm company , hangzhou , china ) according to the manufacturer s instructions . serum gal-3 levels were shown as ng / ml . the lowest mean detection limit for gal-3 level was 0.015 ng / ml . all data were evaluated by using spss ( statistical package for social sciences ) 16.0 program for windows . analyses of variance test followed by post hoc scheffe test was used to compare three independent groups . thirty - two patients with chronic hepatitis b ( chb ) with no antiviral treatment and 30 inactive hbv carrier children with hepatitis b were followed up between july 2013 and december 2013 . patients with chronic hepatitis b were defined by the following criteria : 1 ) positive serum hepatitis b surface antigen ( hbsag ) lasting at least 6 months prior to obtaining of blood samples ; and 2 ) for hepatitis b e antigen ( hbeag ) positive patients [ serum hbv dna level 20 000 iu / ml and serum alt level 1.5upper limit of normal values ( uln ) ; for hbeag negative patients , serum hbv dna 2000 iu / ml and serum alt 1.5uln ] . inactive hbv carrier patients were defined by the following criteria : 1 ) positive serum hbsag from at least 6 months prior to obtaining of blood samples ; 2 ) serum hbv dna level < 2000 iu / ml and serum alt levels < uln ; and 3 ) negative serum hbeag . control subjects were recruited from children who applied for routine check - up or elective surgery such as hernia repair or circumcision . control subjects had no abnormal liver function or hepatitis b tests , and no history or findings of any systemic disease . the basic laboratory tests of all subjects including serum glucose , albumin , alanine aminotransferase ( alt ) , aspartate aminotransferase ( ast ) , gamma - glutamyl transferase ( ggt ) , total bilirubin ( tbil ) , prothrombin time ( pt ) and activated partial thromboplastin time ( aptt ) were recorded . patients that were under 2 years or older than 18 years of age were excluded from the study . patients that received hepatotoxic drugs or had other causes of acute or chronic hepatitis ( wilson disease , autoimmune hepatitis , 1-antitrypsin deficiency , metabolic disease and co - infection or superinfection of hepatitis d virus infection and hepatitis c infection ) were also excluded . informed consent was obtained from parents or legal guardians of the subjects and the study protocol was approved by the local ethics committee . serum glucose , albumin , alt , ast , ggt , tbil , pt , and aptt were measured by enzymatic colorimetric method using an abbot architect c16000 ( illinois , united states ) . serum gal-3 levels were measured by using a commercial quantitative enzyme - linked immune sorbent assay ( elisa ) ( eastbiopharm company , hangzhou , china ) according to the manufacturer s instructions . serum gal-3 levels were shown as ng / ml . the lowest mean detection limit for gal-3 level was 0.015 ng / ml . all data were evaluated by using spss ( statistical package for social sciences ) 16.0 program for windows . analyses of variance test followed by post hoc scheffe test was used to compare three independent groups . the study group included 32 chb patients ( 19 male /13 female ) , 30 inactive hbv carrier patients ( 16 male / 14 female ) and 30 healthy children ( 16 male /14 female ) . the age was 11.73.0 years in the chb group , 12.32.5 years in the inactive hbv carrier group , and 11.72.7 years in the control group . demographic characteristics including age , gender , body mass index , and laboratory test results of chb , inactive hbv carrier , and the control groups are summarized in table 1 . significantly higher serum gal-3 levels were found in the chb group compared with hbv carrier and the control groups ( 16.53.6 ng / ml , 1.10.3 ng / ml , 0.70.5 ng / ml , respectively , p<0.001 ) ( figure 1 ) and no significant difference was found in the gal-3 levels of inactive hbv carrier and the control groups ( p>0.05 ) . similarly , serum alt levels ( 80.230.6 , 26.812.6 , 28.14.4 iu / l , respectively , p<0.001 ) were found to be significantly higher in the chb group than other groups ( p<0.001 ) and no significant difference was found in the alt levels of inactive hbv carrier and the control groups ( p>0.05 ) . chb group had significantly higher ggt levels ( 51.327.5 iu / l ) compared with the inactive hbv carriers ( 35.710.1 no significant differences were found in aptt , inr , and serum albumin and glucose levels between the three groups ( p>0.05 ) ( table 1 ) . there was a positive correlation between gal-3 and serum alt levels in the chb group ( r=0.82 , p<0.001 ) . however , no correlations of gal-3 were found with serum albumin , glucose , ggt , aptt , and inr values in the chb , inactive hbv carrier , or the control groups ( p>0.05 for each ) . in this study , we analyzed gal-3 levels in different phases of hbv infections and healthy subjects by elisa to investigate the possible benefit of gal-3 as a diagnostic marker for chronicity . the results of the present study indicated that , in patients with serologically - proven chb , serum levels of gal-3 levels were significantly higher than those of inactive hbv carrier and healthy controls . chb infection is a common infection worldwide and has some important clinical complications such as cirrhosis and hcc . treatment decision is based on alt levels , hbeag positivity , hbv dna level , and liver histology . family history of hcc , co - existing liver diseases , and patient s treatment history were also important points for treatment decision . inteleukin-10 ( il-10 ) is a cytokine which is produced by t helper type 2 cells . il-10 has effect on inhibition of pro - inflammation cytokines , regulation of humoral immunity , and termination of inflammation . an experimental autoimmune encephalomyelitis model demonstrated that gal-3 plays an important role in decreasing il-10 production . decreasing il-10 may contribute to the sustaining of hbv replication and may initiate chronic hbv infection , which may direct fibrogenesis via inhibition of ifn- secretion . although we did not measure il-10 in our patients , gal-3 may contribute to chronicity of hbv infection by decreasing il-10 . measurement of il-10 together with gal-3 in children with hepatitis b may be a subject of further studies . histologic changes of liver can be shown by liver biopsy , which is an invasive technique . in addition to being an invasive method , liver biopsy is a painful process and accuracy of biopsy depends on suitability of biopsy specimen and experience of pathologist . although , some non - invasive techniques such as fibroscan have been suggested in order to predict to chronicity and fibrosis status of chronic chb infection , these methods are still not validated . in a multicenter study , fibroscan was shown to be useful for determining diagnostic accuracy for cirrhosis , but not significant for fibrosis . therefore , further non - invasive methods are needed to predict entering chronic phase or development of complications with avoidance of liver biopsy . because of possible role of gal-3 in the promoting of inflammation and leading to chronic hepatitis , it can be accepted as a useful biomarker indicating liver inflammation and chronic phase of chb as a non - invasive technique . to the best of our knowledge , the presented study is the first that investigates association between chb infection and serum gal-3 levels in childhood . gal-3 has a carbohydrate recognition domain which is activated by the ligand interaction and has powerful affinity for -galactosides . gal-3 may contribute some cellular processing which may result in fibrosis development , cancer progression , and tissue remodeling . moreover , galectins are expressed in immune cells such as activated macrophages , mast cells , and eosinophils . that s why they may have acute and chronic immunologic effects such as production of some cytokines and mediators as well as apoptosis and chemoattraction . in a previous experimental study , the severity of the liver damage during the chb infections was assessed by some biochemical markers including alt , ast , ggt , alkaline phosphatase , bilirubin , serum albumin , and globulin levels . in present study , alt levels , which reflect ongoing liver damage , were found to associate with gal-3 levels in chb group . higher ggt activities have also been reported in cholestatic liver disease , and other hepatic disorders related to the biliary tract . in addition , previous studies have suggested that increased levels of serum ggt indicated advanced liver fibrosis . the results of our study showed no significant positive correlation between serum ggt and gal-3 level . probably , our finding related to lack of correlation between ggt and gal-3 levels may be a reflection of hepatocyte injury due to chb infection rather than cholestatic hepatitis in our patient group . the pathogenesis of chronic hbv infection and how hbv infection maintains its chronic persistent infection is not fully understood . we believe that our results may be evidence for the role of gal-3 in both the inflammatory process and the development of chronicity in chb infections . serum il-10 levels of our study population were unavailable which might increase the value of the results . the present study demonstrated that gal-3 may be beneficial for predicting chronicity in childhood chronic hbv infection . understanding the role of gal-3 in hbv infections may contribute to the explanation of the pathogenesis of chb infections . further investigates are needed to explain the precise mechanism(s ) of gal-3 in chb infection .