Subtle abnormal events in videos often manifest as weak spatio-temporal cues that are easily overlooked by conventional anomaly detection systems. Existing video anomaly detection approaches typically provide coarse binary anomaly decisions without interpretable evidence, while large vision-language models (LVLMs) can produce textual judgments but lack precise localization of subtle visual signals. To address this gap, we propose Text-guided Fine-Grained Video Anomaly Understanding T-VAU, a framework that grounds subtle anomaly evidence into multimodal reasoning. Specifically, we introduce an Anomaly Heatmap Decoder (AHD) that performs visual-textual feature alignment to extract pixel-level spatio-temporal anomaly heatmaps from intermediate visual representations. We further design a Region-aware Anomaly Encoder (RAE) that converts these heatmaps into structured prompt embeddings, enabling the LVLM to perform anomaly detection, localization, and semantic explanation in a unified reasoning pipeline. To support fine-grained supervision, we construct a target-level fine-grained video-text anomaly dataset derived from ShanghaiTech and UBnormal with detailed annotations of object appearance, localization, and motion trajectories. Extensive experiments demonstrate that T-VAU significantly improves anomaly localization and textual reasoning performance on both benchmarks, achieving strong results in BLEU-4 metrics and Yes/No decision accuracy while providing interpretable pixel-level spatio-temporal evidence for anomaly understanding. The code will be available at https://github.com/momiji-bit/T-VAU.