Free N-acetylneuraminic acid (Neu5Ac) in serum is used as a biomarker for early diagnosis of pneumoconiosis. In this study, a novel adsorbent, molecularly imprinted polymers (MIPs) coated on the surface of metal–organic frameworks (MOFs) were synthesized for the specific adsorption of free Neu5Ac in human serum. This novel adsorbent exhibited the advantages of large adsorption capacity, fast mass transfer rate, and high specificity to Neu5Ac. The theoretical maximum adsorption capacity was 52.31 mg g−1, and the adsorption equilibrium could be reached in 2 min. The free Neu5Ac in serum samples was determined by liquid chromatography–tandem mass spectrometry (LC–MS/MS). The linear range of the detection system was 50 – 10000 ng mL−1. The limit of detection (LOD), and the limit of quantitative (LOQ) was 3 and 10 ng mL−1, respectively. The recoveries in serum samples were between 83.54 % and 92.21 %. The method has been successfully applied to the analysis of free Neu5Ac in serum samples of pneumoconiosis patients without protein precipitation. The content of free Neu5Ac ranged within 199.9 – 235.3 ng mL−1 in healthy group and that in pneumoconiosis group ranged within 266.1 – 292.5 ng mL−1. A significant difference existed in free Neu5Ac between healthy volunteers and patients with pneumoconiosis stage I. The method can effectively remove matrix interference and enrich target analytes, and has broad application prospects in clinical detection.