A male adult skeleton from the Han Dynasty in Shaanxi, China (202 BC–220 AD) with bone changes that possibly represent spinal tuberculosis

Abstract Bioarchaeological data for tuberculosis (TB) have been published very sporadically in China or the rest of East Asia. To explore the history of TB in this area, 85 skeletons excavated from the Liuwei Cemetery in Shaanxi, China (202 BC–220 AD) were macroscopically examined to record TB related bone changes. These skeletons represented inhabitants of Maolingyi, an urban area that had a high population density during the Han Dynasty (202 BC–220 CE). Seventeen of the 85 skeletons had spines that were well enough preserved to observe evidence of spinal disease. Among them, a male skeleton aged around 30 years (M34-E) manifested multiple lytic lesions in the eleventh thoracic to second lumbar vertebral bodies (T11 to L2). TB was considered a possible diagnosis for the spinal lesions observed, with differential diagnoses of brucellosis and typhoid. The dense population and overcrowding in urban Maolingyi were considered the potential social risk factors for TB found at this site. The findings of this study contribute to limited knowledge about the history of TB in East Asia and suggest a relationship between population density and the spread of TB in Maolingyi at that time. However, the lack of published bioarchaeological data of TB in East Asia hinders understanding the transmission of TB within Asia and its link to the rest of the world. Further intensive review of archaeological skeletons in Asia is urgently needed. 中文摘要 中国乃至东亚地区的生物考古学研究中鲜有关于结核病的报道。本文通过鉴定中国陕西留位汉墓出土人类骨骼的相关病变情况, 为中国古代结核病的研究提供新的资料。85例人类骨骼个体中, 共有17例个体的脊柱保存较好, 可以观察结核病的脊柱病变。这其中, 一例30岁左右男性个体的第十一胸椎、第二十胸椎、第一腰椎和第二腰椎的椎体均存在多处溶骨性病变。通过鉴别诊断, 可知造成上述骨骼病变的病因最有可能是结核病。除此之外, 布鲁氏菌病和伤寒病也有可能导致类似的脊柱病变。根据留位墓地的地理位置、年代以及相关历史背景, 可知墓地人群极有可能是汉代茂陵邑的居民, 而茂陵邑拥挤的城镇生活环境很有可能是造成结核病传播的重要社会因素。本文不仅为东亚古代结核病的研究提供了新的资料, 同时也阐释了中国古代结核病的传播与人口密度之间的关系。由于亚洲地区结核病的生物考古学研究仍然存在诸多不足, 因此亟需对亚洲古代人类骨骼进行系统的研究。