Under the background of climate warming, extreme climate poses a serious threat to vegetation. The response of vegetation to extreme climate is spatially heterogeneous, which is influenced by factors such as vegetation type and soil composition. China has complex topographic and climatic conditions, which make the vegetation types vary in its different regions. Analyzing the response patterns of vegetation to extreme climate in different regions is of particular importance to advance our understanding of the relationship between vegetation and climate and to develop measures to address extreme climate conditions. The main purpose of this study is to explore the spatiotemporal changes in normalized difference vegetation index (NDVI) and extreme climate, and analyze the effects of extreme climate on vegetation NDVI within various vegetation regions. Based on climatic data and NDVI data, the study firstly explored the spatiotemporal changes of NDVI and 27 extreme climate indicators across different vegetation regions in China from 2001 to 2020 by the Theil Sen Median slope estimation and Mann Kendall trend test methods. Then, the correlation analysis and random forest importance ranking method were used to analyze the relationship between different extreme climate indicators and the NDVI and further discuss the variations in vegetation response to extreme climate across different vegetation regions. The results indicated that:(1) the annual maximum value of NDVI (NDVI_max) of the whole study area and various vegetation regions showed a significant increasing trend. Among them, the temperate coniferous and deciduous broad-leaved mixed forest area exhibited the strongest increasing trend, while the alpine vegetation area of Qinghai-Tibet Plateau showed the weakest increasing trend. (2) The extreme heat indicators increased significantly. Except for consecutive dry days (CDD), the extreme precipitation indicators showed an increasing trend in the eastern study area and a decreasing trend in the southwest. (3) The extreme climate indicators that had the greatest influence on NDVI_max in different vegetation regions were different. In the cold temperate coniferous forest area, warm spell duration indicator (WSDI) had the greatest effect. In the temperate coniferous and deciduous broad-leaved mixed forest area and tropical monsoon rainforest and rainforest area, the maximum daily minimum temperature (TNx) had the greatest effect. In warm temperate deciduous broad-leaved forest area and subtropical evergreen broad-leaved forest area, simple daily intensity indicator (SDII) had the greatest effect. In temperate grassland area, maximum daily maximum temperature (TXx) had the greatest effect. In temperate desert area, annual precipitation total (PRCPTOT) had the greatest effect. In the alpine vegetation area of the Qinghai-Tibet Plateau, ice days (ID) had the greatest effect.