There are rare studies assessing the efficacy of inhaled glucocorticoids (ICS) , the common therapy for chronic obstructive pulmonary disease (COPD) . MicroRNAs (miRNAs) have been confirmed to be involved in the development of COPD, among which miR-210 and miR-181a are closely related to COPD. Moreover, there is lack of clinical research on changes of miR-210 and miR-181a in COPD patients treated with ICS.

To examine the changes and response predictive values of serum miR-210 and miR-181a levels in stable COPD patients treated with ICS.

Eighty-six COPD outpatients were recruited from 363 Hospital from January 2017 to June 2020. All of them received four-week budesonide and formoterol inhalation. Treatment efficacy was assessed by the results of spirometry test or COPD Assessment Test (CAT) 〔responsive to treatment was defined as the COPD stage was reduced at least one stage or CAT score was reduced at least 2 points after treatment〕. Pre- and post-treatment lung function parameters〔including forced expiratory volume in one second (FEV₁) , forced vital capacity (FVC) , and peak expiratory flow (PEF) 〕 and serum miR-210 and miR-181a levels were collected. Pearson correlation analysis was used to assess the associations of serum miR-210 and miR-181a levels with FEV₁, FVC, and PEF as well as CAT score before and after the treatment. ROC analysis was used to assess the predictive values of serum miR-210 and miR-181a levels for treatment response in stable COPD.

Compared with pre-treatment, stable COPD patients demonstrated significantly increased values of FEV₁, FVC, and PEF, and significantly decreased CAT score, serum miR-210 and miR-181a levels after treatment (P<0.05) . Serum miR-210 and miR-181a levels were positively correlated with the CAT score before the treatment (P<0.05) . Serum miR-210 and miR-181a levels were negatively correlated with FEV₁ after the treatment (P<0.05) . Patients with responses to treatment had significantly lower pre- and post-treatment serum miR-210 and miR-181a levels compared with those without (P<0.05) . In predicting the treatment response in stable COPD, the AUC of pre-treatment serum miR-210 level was 0.807, and that of pre-treatment serum miR-181a level was 0.844 (P<0.05) .

The serum levels of miR-210 and miR-181a were much lowered in stable COPD patients with responses to four-week budesonide and formoterol inhalation. Pre-treatment serum miR-210 and miR-181a levels might be effective predictors of treatment response.

吸入性糖皮质激素（ICS）是慢性阻塞性肺疾病（COPD）的常用治疗药物，但其治疗效果评价研究较为缺乏。微小核糖核酸（miR）被证实参与COPD的发病，其中miR-210、miR-181a与COPD患者关系密切。目前临床有关miR-210、miR-181a与COPD患者ICS治疗效果的关系研究较为缺乏。

探讨血清miR-210、miR-181a表达水平与COPD稳定期患者ICS治疗效果的关系及其预测价值。

收集2017年1月至2020年6月于三六三医院门诊治疗的COPD稳定期患者86例，行布地奈德福莫特罗粉吸入剂治疗4周后进行治疗效果评价，将肺功能分级降低≥1个级别或慢性阻塞性肺疾病评估测试（CAT）评分降低≥2分判断为有效并归为有效组，其余纳入无效组。检测患者治疗前后的肺功能指标〔包括用力肺活量（FVC）、第一秒用力呼气容积（FEV₁）、最大呼气流量（PEF）〕、CAT评分与血清miR-210、miR-181a表达水平。采用Pearson相关分析探讨ICS治疗前与治疗4周后血清miR-210、miR-181a表达水平与肺功能指标、CAT评分的相关性，并绘制ROC曲线以分析血清miR-210、miR-181a表达水平对COPD稳定期患者ICS治疗效果的预测价值。

ICS治疗后，COPD稳定期患者FVC、FEV₁、PEF等高于治疗前，CAT评分及血清miR-210、miR-181a表达水平低于治疗前（P<0.05）。ICS治疗前患者血清miR-210、miR-181a表达水平与CAT评分呈正相关（P<0.05）。ICS治疗后患者血清miR-210、miR-181a表达水平与FEV₁呈负相关（P<0.05）。有效组治疗前与治疗后的血清miR-210、miR-181a表达水平低于无效组（P<0.05）。治疗前miR-210、miR-181a表达水平预测COPD患者ICS治疗效果的ROC曲线下面积为0.807、0.844。

ICS治疗有效的COPD稳定期患者治疗前与治疗后的血清miR-210、miR-181a表达水平均低于无效患者，且治疗前血清miR-210、miR-181a表达水平可较好地预测ICS治疗效果。